Democrats put health reform on faster track

Budget agreement bars a filibuster and riles the GOP

By Lisa Wangsness
Globe Staff / April 25, 2009
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Congressional Democrats reached a tentative deal yesterday that will let the Senate pass a healthcare overhaul with a simple majority, rather than the 60 votes needed to overcome a Republican filibuster, dramatically increasing the odds of passing sweeping changes to the country's healthcare system this year.

The agreement would let a simple majority rule only if the Senate fails to pass a healthcare bill by Oct. 15, essentially setting a deadline for a bipartisan plan, said a source with knowledge of the agreement who was not authorized to speak publicly.

Liberal Democrats want to pass a healthcare plan without making extensive concessions to Republicans, who have already declared themselves unwilling to consider changes important to healthcare advocates, such as creating a new government insurance program.

"It's an incredibly important moment," said Richard Kirsch, president of Health Care for America Now, a large Democratic coalition of unions, health providers, and activist groups. "It changes the whole dynamic because it allows Democratic leadership to stand fast on the fundamentals of reform that they think and we think are necessary to make change work."

Some Democrats believe the threat of a lower threshold for passage would give Republicans an incentive to work collaboratively, but yesterday the effect was to instantly intensify the partisan rancor that has been building all year.

Republicans declared that by using the tactic, known as reconciliation, to make an end-run around Senate rules that normally set the bar higher for important legislation, President Obama and Democratic leaders had abandoned their commitment to work in a bipartisan manner.

"The American people expect that when you take on an issue that affects them in a very comprehensive way as healthcare does . . . there is going to be an effort to have a fair plan produced that they have confidence was reached in balanced way. That means you need bipartisanship and participation by all stakeholders," said Senator Judd Gregg, a Republican from New Hampshire. "What you've essentially got here is negotiations where one side decides to pick up a gun and load it, and the other side has the gun pointed at its head."

The challenge before Congress is one both parties recognize, and one Obama promised in his campaign to address: to provide better access to health insurance for the 47 million Americans without coverage while improving quality and lowering the cost of care, which is on track to consume 20 percent of the US economy by 2018.

Senator Max Baucus of Montana, who has been writing a healthcare bill with Senator Edward M. Kennedy of Massachusetts, said going the fast-track route could make it harder to win Republican support needed to pass legislation that would be broadly accepted. Baucus has a strong relationship with Senator Charles Grassley of Iowa, the ranking Republican on the Finance Committee, and he has previously said he hoped to win as many as 75 votes for a healthcare bill.

"When you jam something down somebody's throat, it's not sustainable," Baucus told reporters yesterday. "And I want something that will last."

But the White House and many Democrats, particularly in the House, see reconciliation as an essential tool to ensure that a health bill passes. Pointing to the president's economic stimulus package, which drew three Republican votes in February, they say Republicans have shown little interest in working together.

Harry Reid, the Senate majority leader, said the maneuver would be used only "when bipartisan bills are not possible."

Kennedy, who has been working on creating a healthcare bill for most of the last year, has been meeting and talking to key Republicans as well as Democrats about what it should contain.

"Reconciliation is only a tool of last resort, and there is agreement that a bipartisan bill pursued through regular order is the best outcome," Anthony Coley, a spokesman for Kennedy, said in a statement.

The early reaction from Republicans yesterday, however, raised the possibility that the reconciliation threat could drive Republicans away from the negotiating table.

"The partisan side of me says, 'Go for it,' because if they do that, they're going to get hung with the worst healthcare bill in history," said US Senator Orrin Hatch, a Republican from Utah who has previously worked with Kennedy on major health legislation. "With all the complexities of healthcare, you cannot please all of the stakeholders, and if they make it a partisan exercise, my gosh, we'll beat them up for the rest of their lives."

Under usual Senate rules, 60 votes are needed to advance a major bill, but under reconciliation, passage of the budget plan would let Democrats push through healthcare with a majority and after only 20 hours of debate. Democrats hold 56 of the 100 seats in the Senate, and two independents typically vote with the party.

Reconciliation is supposed to be for matters involving revenue; Republicans used it on many occasions during the Bush administration to pass legislation. It was not clear yesterday whether all of the elements of a healthcare bill would qualify under parliamentary rules to be passed under reconciliation. Such questions may have to be resolved by the Senate parliamentarian.

Democratic leaders also agreed in their tentative budget deal not to use reconciliation to pass anti-global-warming legislation, which could raise energy prices for consumers. An aide to Representative Edward J. Markey, a Massachusetts Democrat and coauthor of the legislation, said that Markey had always expected the climate change bill to move through the Senate under the normal rules and that his committee was on track to determine details of its version of the legislation next week.

The reconciliation deal is part of a House-Senate compromise on the slightly different versions of Obama's $3.6 trillion spending blueprint for next year that the chambers passed earlier this month. In the compromise, Democratic leaders, queasy about enormous federal deficits, decided to allow Obama's $400 middle-class tax cut to expire at the end of 2010.

House leaders hope to pass the budget plan on Tuesday, while the Senate plans to follow suit on Wednesday, Obama's 100th day in office.

Material from the Associated Press was also used in this report.

Senator Max Baucus of Montana said going the fast-track route could make it harder to win GOP support.