Senate committee advances budget resolution; debate remains over whether to use reconciliation to fast track health reform

The Senate Budget Committee on Thursday voted 13-10 along party lines to approve a $3.5 trillion fiscal year 2010 budget resolution that does not include budget reconciliation instructions for comprehensive health care reform legislation, CQ Today reports (Clarke et al., CQ Today, 3/26).

The House Budget Committee on Wednesday approved its version of the resolution, which totaled $3.45 trillion. The Senate measure includes President Obama's request for a $634 billion health reserve fund but does not include any further funding.

The committee also approved an amendment, sponsored by Sen. Ben Cardin (D-Md.), that would assure Medicare reimbursements for outpatient treatment (Kivlan, CongressDaily, 3/26). In addition, the committee voted 13-10 to reject an amendment sponsored by committee ranking member Judd Gregg (R-N.H.) that would have required pay/go rules to apply to health care reform legislation (Sanchez, CongressDaily, 3/27). According to committee Chair Kent Conrad (D-N.D.), the Senate resolution would already subject such a bill to pay/go and require costs to be offset within 11 years. The committee also voted 12-11 to reject an amendment sponsored by Sen. Mike Enzi (R-Wyo.) that would have required hospitals and physicians groups to pay a 25% share of the cost of Medicare-funded projects to improve health information technology.

Both chambers are expected to consider the respective resolutions next week. Conrad on Thursday said the Senate will begin debate on its resolution on Thursday with a final vote expected on Thursday or Friday (CongressDaily, 3/27). According to the Washington Post, "Democrats expect the blueprints to easily win approval of the full House and Senate next week" (Montgomery, Washington Post, 3/27).

Republican Alternative

House Republicans on Thursday released an 18-page outline of their FY 2010 budget proposal that includes providing tax incentives to help people purchase health coverage, CQ Today reports. According to the outline, the proposal would expand access to health care "through policies that will provide tax incentives for millions more working families and small-business owners to obtain access to coverage" (Krawzak, CQ Today, 3/26).

According to the Washington Times, "On issues such as health care, energy, the deficit and national debt, the Republican document was little more than a statement of broad principles" (Rowland, Washington Times, 3/27). The full alternative budget, including spending and revenue numbers, will be released next week, CQ Today reports (CQ Today, 3/26).

Reconciliation

House and Senate Democrats on Thursday debated over whether to use budget reconciliation, which requires only 51 votes in the Senate to avoid the threat of a filibuster instead of the normal 60, to pass comprehensive health care reform legislation, Politico reports. Currently, the House's pending budget resolution includes health care reconciliation instructions while the Senate bill does not. Reconciliation could be included in the compromise bill.

House Speaker Nancy Pelosi (D-Calif.) said in her weekly press conference "I believe it's absolutely essential that we come out of this year with a substantial health care reform," adding, "I believe that is best served by having reconciliation in the package." Senate Finance Committee Chair Max Baucus (D-Mont.) on Thursday warned that using reconciliation would prompt a partisan battle that would undermine the policy and lead to a weaker legislation (Raju/Isenstadt, Politico, 3/26). "We'll get a much better chance at getting better, more meaningful health care reform," with bipartisan support, which is "better accomplished by not going to reconciliation," Baucus said (Lengell, Washington Times, 3/27). Baucus noted that "many, many Democrats in the Senate do not think it's a wise move." Sen. Ben Nelson (D-Neb.) said that he would not vote for the legislation if budget reconciliation is used.

A number of Senate moderates, including Sens. Judd Gregg (R-N.H.) and Susan Collins (R-Maine), have suggested that Pelosi is using the threat of reconciliation as a bargaining strategy (Politico, 3/26). Senate Minority Whip Jon Kyl (R-Ariz.) said that House leadership was using reconciliation to "sneak through" health reform, calling reconciliation, "a special rule that was never intended to create energy or health care policy for our country -- issues so significant that our regular order should prevail" (Washington Times, 3/27).

Meanwhile, Senate Majority Leader Harry Reid (D-Nev.) on Thursday said that he was not ruling out the possibility of using the budget reconciliation process to advance health care reform, CQ Today reports. Reid added that the decision on whether to use reconciliation, which is included in the House's version of the resolution, will be decided in conference committee. He said, "We're taking nothing off the table," adding, "We're going to work during the (April) recess ... to see what we're going to do about having a (budget resolution) conference report that is going to be passed over here and passed in the House" (CQ Today, 3/26).

Editorial

For Obama's FY 2010 budget proposal "to work," he and Congress must "scale this vision back and accomplish some things, such as entitlement and health care reforms, that have proved politically impossible in the past," a Portland Press Herald editorial states. While Obama has said that he is "open to stripping some measures out" of his proposal, one "exception is Obama's commitment to health care reform," according to the Press Herald. The editorial continues, "Out-of-control health costs do create a brake on economic growth and a disadvantage for U.S. companies" and "burden Medicare and Medicaid ... straining the budget and adding to deficits."

While "[i]t may be impossible to complete health care reform in one year ... there is a unique opportunity that should not be missed to get started on a plan," according to the Press Herald (Portland Press Herald, 3/26).

Opinion Piece

The 57% of U.S. residents who believe Obama is "doing too much" by attempting to address the economy, health care, education and energy do so based on a "flawed assumption -- that fixing the economy can be separated from health care, education and energy," syndicated columnist Froma Harrop writes in a Providence Journal opinion piece. She continues, "If Obama ever has to throw any of them off the agenda island, he must ensure that health care reform [remains] a survivor," as the "inability to afford needed medical treatment is among Americans' most primal economic fears."

Harrop writes, "In the bigger picture, soaring health care costs are busting federal and state budgets" and are putting "Americans at a comparative disadvantage to foreign companies whose governments curb medical spending." For the U.S. to close the health care gap, the government "can curtail unnecessarily expensive care," in part by funding comparative effectiveness research, she writes.

Harrop continues, "The challenge for reformers will be gaining the trust of Americans happy with their coverage" and that many U.S. residents "fear that a national plan would compromise the quality of care they've come to expect." She adds, "The time to establish their trust is right now, while the Obama administration is still young and enjoying much good-will."

Harrop writes, "In sum, the president's push for health care reform amid economic crisis is not a symptom of any attention-deficit disorder," adding, "It is making good use of political momentum while it lasts" (Harrop, Providence Journal, 3/26).