The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Health Care Reform Effort Will Continue, But Fate is Uncertain

Posted by Alan on February 27, 2010

With the bipartisan health care reform summit history, President Barack Obama is turning to the future of his push to revamp America’s health care system. Here’s a simple way for President Barack Obama to demonstrate a commitment to cost containment and bi-partisanship. As he said in his weekly address this morning, “I am eager and willing to move forward with members of both parties on health care if the other side is serious about coming together to resolve our differences and get this done.”

He also made clear, however that he would move forward without Republican support if that was necessary. “I also believe that we cannot lose the opportunity to meet this challenge,” he said, concluding, “It is time for us to come together.  It is time for us to act.  It is time for those of us in Washington to live up to our responsibilities to the American people and to future generations.  So let’s get this done.”

The other day I wrote about the three step process Democrats are likely to use to attempt to pass comprehensive health care reform. To summarize: House Democrats would pass the health care reform previously passed by the Senate. The Senate would pass a clean-up bill (which I’ve also heard referred to as “sidecar legislation”) that makes fixes the House and President Obama want that impacts costs and taxes. The House passes the clean up bill. The President signs both bills and health care reform, Democratic-style, is the law of the land.

Turns out this gambit, while legal and within Congressional rules, doesn’t play out as cleanly as I’d first surmised. John Nelson, a regular reader, brought to my attention that there are various ways Republicans can slow this process down to a crawl. The GOP could not filibuster the sidecar legislation because it is being considered under what’s called the reconciliation process. However, they may not need to. Under the rules governing the reconciliation process Republicans can introduce an almost unlimited number of amendments. While in theory the reconciliation process limits debate to 20 hours, the amendments could stretch out the debate for weeks.

As President Obama accurately noted during the health care reform summit, most Americans care more about the substance of health care reform than the process. However, it’s equally true that the legislative procedures used to push the issue this far have created a cloud over the substance of reform. Republicans have artfully used the messy give-and-take typical when drafting major legislation and cast it as a reason to oppose what was drafted. Some of these criticisms, such as the deals cut to favor specific states, are valid; others, such as condemning the legislation because the bills themselves are large, are spurious. But what’s undeniable is the drumbeat of criticism concerning process has undermined the substance of the bill (of course the serious problems with the substance of the bill hasn’t bolstered it’s popularity either).

If the Democrats could accomplish their legislative maneuvers quickly attention would shift to he substance of the legislation long before the November elections. In other words, like yanking off a bandage, the political pain generated by the process would be over quickly. If Republicans force Democrats to spend weeks mired in process, however, the political pain becomes increasingly greater – and perhaps unbearable.

What all this means is that the odds of comprehensive health care reform passing have improved considerably since the election of Scott Brown to the Senate from Massachusetts and the subsequent loss of the Democratic caucus’ 60 vote, filibuster-busting majority. But those odds haven’t increased as much as a I thought when I wrote about the three-step process Democrats would likely use to enact the reform legislation.

There are smart people on both sides of the issue. There are passionate people on both sides. The effort to pass – and to defeat – health care reform will continue. How it ends is anyone’s guess at this point.


9 Responses to “Health Care Reform Effort Will Continue, But Fate is Uncertain”

  1. Rick said

    None of you have mentioned that the country cannot afford this reform as proposed.

  2. Nosedoc said

    While the health care reform posturing by both parties has dominated the headlines, the Sustainable Growth Rate formula-dictated, across the board 21% cut in Medicare reimbursements to health care providers has been allowed to go into effect as of tomorrow morning. An effort to eliminate the SGR formula altogether failed to pass in the Senate after a similar bill was easily passed by the House a few months ago. A measure that would have maintained current fees for another 30 days (to buy time for a more permanent fix) was also quashed by the Senate, with Senator Jim Bunning taking the lead. The Center for Medicare and Medicaid Services has instructed its contractors to suspend processing claims for the next 10 to 14 days, in the event that the Congress should regain its senses by eliminating or once again postponing the cuts.

    I don’t believe it requires an economic whiz to extrapolate the consequences of this bill for medical and surgical practices that are dependent on Medicare reimbursements for their viability, and how this may impact unemployment statistics as practices lay off employees or simply close. As I have said in the past, there is a “to heck with it point” for health care providers, and I think this point will be surpassed for many if this cut is allowed to remain in place. The impact on Medicare beneficiaries would be more substantial, as many practices would go non-par to mitigate the cuts, requiring the patients to pay at the time of service for outpatient services while getting reimbursed 80 to 100% depending on the degree of secondary coverage. Other practices, such as orthopedic and neurosurgical practices, might simply opt out of the Medicare program altogether, creating an access problem for seniors not seen since prior to the creation of the Medicare program.

    • Nosedoc:

      Yup! And the public who you and we serve doesn’t have a clue about what is about to hit them, “right in the nose (forgive the pun).

      Unfortunately, these paybacks won’t be awesome, they will be terribly sad.

      It is too bad that no one bothered to tell them the truth. Certainly didn’t expect the Obama Company, or the Congress to do so, did you?

  3. Spencer, you are so correct. A good deal of Dems and Republicans don’t represent their constituents.

    Did anyone catch that everytime a republican would give factual research from the CBO that said the proposed bill would raise premiums, and raise the deficit, the dems would scold the republicans for not trying to find something they agread with about the bill.

    • Yes, AIM, I’ve noticed.

      Thanks for your support. I find the current “flavor of the month” with our Congress and Administration to be one of “We don’t care, WE don’t have to, We are the Governing Body”, forgetting who pays their salaries and retirement plans.

      Why do we do that? 😦

      • BTW, do you remember, before the days of regulations (not suggesting that it was good, mind you) when we had bumper stickers that said, “We don’t care; we don’t have to, we’re the telephone company!”.

        What has changed?

  4. Helen said

    John is right about amendments disrupting the passage of healthcare reform BUT Dems can move to waive them and then vote to do so. Since all that is needed are 50 votes plus Joe Biden, the Dems will prevail.
    Check out the article on

    Gotta love the hypocrisy of it all. The Repubs use reconciliation when it suits them (tax cuts X2, Medicare Part D) and rail against it when it doesn’t.

    • “Gotta love the hypocrisy of it all. The Repubs use reconciliation when it suits them (tax cuts X2, Medicare Part D) and rail against it when it doesn’t.”

      Helen, don’t they both? Both parties have become caricatures of themselves. They are equally corrupt, do a piss-poor job of representing their constituents, are self-aggrandizing ego-maniacal parties whose Members (those serving in Congress) are filled with a great deal of self-importance.

      It is time for serious political reform.

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