Democratic leaders still pondering reconciliation pros and cons for health bill

Congressional Democrats are facing a critical decision about whether to use the procedural maneuver known as budget reconciliation to pass a health care reform bill, The New York Times reports. Democrats could push the measure through the Senate with a simple majority vote but could trigger "a political backlash." 

"The procedure is also subject to complex rules that could make it difficult for Democrats to include all the provisions needed to win approval of the bill, especially among rank-and-file House Democrats. For instance, it might be difficult to include provisions related to insurance coverage for abortions." Top Democrats have long known that they may need to use reconciliation, The Times reports, adding that leaders are "no longer confident" some House Democrats "would be willing to go along" with the vote(Herszenhorn and Pear, 1/25).

Related KHN story: How The Budget Reconciliation Process Works (1/21).

"Only changes that affect taxes and government spending would normally be allowed to pass with a majority of 51 senators," The Associated Press reports. It's a "politically risky" strategy. "There is widespread support for Obama's goals of expanding coverage to nearly all Americans while trying to slow costs. But polls show the public is deeply skeptical of the Democratic bills, and Republicans would accuse Democrats of ignoring voters' wishes" (Alonso-Zaldivar, 1/26).

The Associated Press also covers a poll by the Robert Wood Johnson Foundation, conducted between Nov. 28 and Dec. 20 (before the Senate vote) that showed public "fears about President Barack Obama's health care overhaul increased significantly in December" (Werner, 1/25).

Politico reports that writing a new bill isn't out of the question. "The idea, floated last week by President Barack Obama and some congressional Democrats, is to pluck reform's most popular ideas and write a new bill with enough support to breeze through Congress. But there are many pitfalls that could doom such an effort. After more than a year of work, lawmakers are trying to finish reform quickly, and a new bill would have to be written and approved by both chambers" (Frates, 1/26).

Roll Call reports that Obama's State of the Union address Wednesday could offer him "last, best chance to reboot his health care agenda. ... Obama's speech isn't expected to resolve every detail, but it could serve as an opportunity to smooth over the intraparty warring that has taken place since the Massachusetts election and make more clear whether he will still push hard for a comprehensive health care bill or dramatically scale back his ambitions, aides said."

An "aide added that Senate Democratic leaders are prepared to promise passage of a package of fixes to appease House concerns, most likely through reconciliation, but that it would be unlikely to happen until after the House took action on the Senate bill" (Dennis, 1/26).

Politico reports in a second story that, meanwhile, "Democratic leaders continued to craft changes to the Senate bill in hopes of winning over liberal House members, including Medicare cuts, tax hikes and increased affordability subsidies, according to sources familiar with the discussions." Part of the talks center around dropping from the Senate bill the so-called "Cornhusker Kickback" — a provision that would leave the federal government on the hook for a proposed Medicaid expansion in Nebraska. Other proposed provisions include closing the gap in seniors' prescription drug coverage in Medicare Part D and $50 billion more in subsidies to buy insurance for those with lower incomes (Frates and Budoff Brown, 1/25).