Health Care No Stranger To Reconciliation Process To get the president's health care plan passed, Democrats will likely use a process called budget reconciliation, which allows them to prevent a GOP filibuster and advance the bill with a simple majority. Republicans say the process was not designed for such a large bill, but reconciliation has often been used to move major health policy.

Health Care No Stranger To Reconciliation Process

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STEVE INSKEEP, Host:

It's MORNING EDITION from NPR News. Good morning. I'm Steve Inskeep.

RENEE MONTAGNE, Host:

And I'm Renee Montagne.

Supporters of the health care legislation are considering two different ways to pass a bill. One is on display tomorrow, when President Obama convenes a meeting of Republicans and Democrats, which will be televised.

INSKEEP: The other way to pass a bill is under discussion in Congress. It's a method that would bypass unanimous Republican opposition. Right now, you need 60 votes to prevent a bill from being talked to death, votes the Democrats no longer have. A method called budget reconciliation would allow Democrats to pass the bill with just 51.

MONTAGNE: One question now is whether that would break Senate tradition.

NPR's Julie Rovner reports.

JULIE ROVNER: To listen to Republicans, you'd think the budget reconciliation process and health care have never crossed paths before. Here's Senate Republican leader Mitch McConnell from this week's "Fox News Sunday," speculating on Democrats' plans.

(SOUNDBITE OF TV SHOW, "FOX NEWS SUNDAY")

MITCH MCCONNELL: Now they are suggesting they might use the device which has never been used for this kind major systemic reform.

ROVNER: And here's Arizona Republican Senator Jon Kyl commenting yesterday.

JON KYL: It was never designed for a large, comprehensive piece of legislation such as health care, as you all know. It's a budget exercise, and that's why some refer to it as the nuclear option.

ROVNER: Congress first began using budget reconciliation to make tax changes and cut deficits in 1980. At about that same time, lawmakers also began using the shortcut process to make changes in health policy, says Sara Rosenbaum, a professor of health policy at George Washington University.

SARA ROSENBAUM: In fact, the way in which virtually all of health reform - with very, very limited exceptions - has happened over the past 30 years has been the reconciliation process.

ROVNER: She says the expansion of health insurance coverage for low income children is a prime example.

ROSENBAUM: In 1980, children who were living at less than half the poverty level in the United States could not get a Medicaid card in half the states if they had two parents at home.

ROVNER: But via a series of budget reconciliation bills, beginning in 1984, Congress began expanding Medicaid coverage. In 1997, also in a budget reconciliation bill, it created the Children's Health Insurance Program, known as CHIP. Today, says Rosenbaum - who helped write many of the children's health provisions in those bills - Medicaid and CHIP together cover one in every three children in the United States.

ROSENBAUM: So literally, we've changed everything about insurance coverage for children and families, and we've changed access to health care all across the United States, all as a result of reconciliation.

ROVNER: Budget reconciliation has also been an important tool for changing Medicare, says Tricia Neuman of the Kaiser Family Foundation.

TRICIA NEUMAN: Going back even close to 30 years, if you start, say, in 1982, the reconciliation bill that year added the hospice benefit, which, of course, is very important to people at end of life.

ROVNER: Reconciliation bills added Medicare benefits for HMOs, for cancer screenings, protected patients in nursing homes, and changed the way Medicare paid doctors. Because the point of budget reconciliation was usually to cut the deficit, the huge Medicare program was nearly always on the chopping block. But Neuman, a former congressional staffer, says there's another reason it became the bill of choice for other far-reaching changes.

NEUMAN: This happened primarily because it was the only train leaving the station, so if policymakers wanted to make a change in health policy, the only way to do it would be to amend a reconciliation bill, and that's really why it happened.

ROVNER: Reconciliation bills have touched other parts of the health care system beyond Medicare and Medicaid, too. For example, the law that lets people keep their employers' health insurance after they leave their jobs is called COBRA, because it was included as one fairly minor provision in a huge reconciliation bill, says Rosenbaum.

ROSENBAUM: The correct name is continuation benefits. And it's only called COBRA today because it was contained in the Consolidated Omnibus Budget Reconciliation Act of 1985, and that is how we came up with the name COBRA.

ROVNER: In fact, over the past three decades, the number of major health financing measures that were not passed via budget reconciliation can be counted on one hand. And one of those was repealed the following year. So using the process to try to pass a health overhaul bill might not be easy, but it won't be unprecedented.

Julie Rovner, NPR News, Washington.

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