The Hitchhiker’s Guide to Health Care This Week

Okay. Let me guess. This will be the make or break week for health care reform.

Over the past year, I can count at least six weeks that have been billed as that singular, crucial week in which the fate of health care swings in the balance.

But none of those weeks have been quite like this one.

This is it.

Starting today, the House launches a series of sequential committee meetings which the Democratic leadership team hopes will result in the health care bill hitting the floor late this week or over next weekend. So I’ve prepared a manual. A cheat sheet. A “hitchhiker’s guide” that will help you navigate the convoluted parliamentary labyrinth that the health care bill is expected to take this week.

And it all begins today.

For starters, House Democrats are short of the votes they need to pass the bill.

“We don't have (the votes) as of this morning. But we've been working this thing all weekend. We'll be working it going into the week,” said House Majority Whip Jim Clyburn (D-SC) on NBC's Meet the Press. But Clyburn indicated Friday that “the votes will be there when we vote.”

There is also still no resolution to the vexing issue of abortion.

These two phenomena put House Democrats precisely where they were last fall in the run-up to the initial health care reform vote. In the end, they prevailed, with the legislation passing 220-215. And deep in the night before the vote, House Democrats also allowed the inclusion of the Stupak Amendment. Named after Rep. Bart Stupak (D-MI) the amendment banned the use of taxpayer money “to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion.”

The inclusion of the Stupak Amendment courted dozens of pro-life Democrats who probably wouldn’t have supported the measure otherwise. The legislation appeared doomed had House Speaker Nancy Pelosi (D-CA) not ordered the inclusion of the Stupak Amendment.

So here’s the timetable for the week:

First, look for the Congressional Budget Office (CBO) to report its “score” or price tag of the legislation. The CBO’s evaluation of the bill is critical to cost-conscious lawmakers. Many remain on the fence for now, waiting to see a dollar figure.

Regardless, the entire plan is expected to lurch into motion today at 3 pm. That’s when the House Budget Committee begins preparing a “reconciliation” resolution.

Now we’ve heard about Democrats possibly using reconciliation for weeks to move their health care bill through the rocky Senate shoals. But what the House Budget Committee does Monday is really the first step in the exercise to launch the Senate's reconciliation effort sometime in the next two weeks.

First of all, what is reconciliation?

Reconciliation is a special parliamentary maneuver available to the House and Senate. It’s typically used in the annual budget cycle. At its most basic level, reconciliation is a method to harmonize tax policy and expenditures. But Senate Democrats want to use reconciliation to pass health care reform because special reconciliation rules ban filibusters. Reconciliation also curbs debate time to 20 hours and restricts amendments.

The use of reconciliation is not an issue in the House. By design, the House has limited debate time. Opportunities to amend are also scant. But the Senate is known as the “deliberative” chamber. And the fundamental glory of the Senate is its unlimited debate and amendment process.
Except of course, during reconciliation.

But if the Senate wants to use reconciliation, it all has to start in the House. Which is why today’s House Budget Committee meeting is so important.

So why must reconciliation start in the House? Article 1, Section 7 of the Constitution mandates that “all bills for raising revenue shall originate in the House of Representatives.”

Now here’s the rub about reconciliation. It deals with money and tax policy (i.e. – bills for raising revenue). Tax provisions and spending are part of the health care bill. So to jumpstart the entire Senate reconciliation process, you must first visit the House.

The plan is for the House Budget Committee to prepare its reconciliation resolution by midnight tonight. If it completes its work (called a markup), the resolution then goes to the House Rules Committee. But not immediately. Budget Committee rules require 48 hours for comment from lawmakers. That arrangement can be waived. But that means that in all likelihood, the Rules Committee can’t tackle the reconciliation resolution until at least Wednesday, if not Thursday.

So why is the Rules Committee so important?

The Rules Committee is the gateway to the House floor. Almost every issue debated in the House must first get a "rule" from the Rules Committee. The “rule” governs the parameters of how lawmakers will handle the legislation on the floor. In other words, the rule establishes how much time is available for debate and what amendments are allowed.

Once the Rules Committee crafts its rule for the reconciliation resolution, the full House must also adopt the rule. If the House defeats the rule, the underlying measure cannot come to the floor.

The Rules Committee is where lawmakers will make the final changes to the reconciliation package. Expect dozens upon dozens upon dozens of lawmakers and their aides to come on bended knee before a very lengthy Rules Committee meeting. They’re trying to get their proposals made in order. Or attempting to Velcro their amendments onto the conclusive version of the plan.

But make no mistake. The Rules Committee is often called the “Speaker’s Committee.” Its membership is always weighted heavily in favor of the majority party. In this case, nine Democrats compared to four Republicans. That’s so the Speaker of the House and the party in charge always gets its way.

The minority party may have broad latitude in the Senate. But the Rules Committee is where a determined majority rules with an iron fist in the House.

Once the Rules Committee finishes, the reconciliation resolution can go to the House floor. Typically, a "rule" must wait overnight before it hits the floor. But that can be waived, too. That means its doubtful the House could debate the package before Thursday. But it’s more likely the health care debate and vote won’t ripen until Friday or over the weekend.

Now before discussing the actual health care debate, there’s another pivotal item the House must grapple with. And the Rules Committee could play a starring role in this, too.

Before the House starts debate on the reconciliation resolution, it must somehow pass the version of the health care bill that the Senate approved Christmas Eve.

Here's why: back in November, the House okayed its version. The Senate followed suit with its own bill in December. And therein lies the problem. They aren't the same piece of legislation.

Before any a bill may become law, the House and Senate must work out the differences and synch up the varying pieces of legislation before sending a unified document to the White House for the president’s signature.

There are two options lawmakers can use to resolve these disputes. They can settle the differences in a “conference committee” or play “Ping-Pong.” A conference committee is a meeting of House members and senators where they negotiate the versions of the legislation passed by their respective chambers. Once a conference committee is complete, the House and Senate must approve the final, definitive version of the legislation, known as a Conference Report. If either body fails to do so, they cannot send the legislation to the president for his signature.

Ping-Pong is different. Under Ping-Pong, the House and Senate bounce the legislation back and forth between the chambers, modifying it each time, until they both approve the same bill.

In this scenario, the reconciliation resolution will be the magical document. But the House and Senate must first must have  something to "reconcile" and make changes to the tax code, etc. So, they both have to approve the same bill, which they haven’t done yet.

So, Democratic leaders believe the easiest route to accomplish this will be an abbreviated match of Ping-Pong. In fact in this case, it will just be a game of “Ping.” The Senate will bounce its version of the health legislation (the one senators passed on December 24) to the House and the House will prospectively adopt that. That way, both the House and Senate are in lockstep. The old health legislation the House adopted in November disappears. And after Mr. Obama signs this, it’s the law of the land.

That is until both the House and Senate pass the reconciliation package.

But one more footnote on the House passing the Senate package. It’s possible the House might not even hold a new debate and final vote on the Senate version of the health care bill. That’s where the Rules Committee comes into play again.

In its creation of a rule to handle the reconciliation resolution, the Rules Committee could potentially forge what’s called a “self-executing rule.” This is in essence a “two-for-one” ploy. In other words, when the House passes the rule governing debate for the reconciliation package, it could simultaneously approve the Senate version of the health bill.

This would be the most-economical way to handle the Senate bill. And self-executing rules are not rare. Just a few weeks ago, the House utilized a self-executing rule to institute PAYGO requirements and synchronously raise the debt limit. The actual bill dealt with establishing mandates for the House to pay for things it elects to spend money on. But thanks to the self-executing rule cooked up by the Rules Committee, the House actually hiked the debt limit when it approved the rule to debate PAYGO.

Now, back to where we were with the House considering reconciliation.

The first issue up on the floor will be the “rule.” This can sometimes be very contentious. Remember, if the rule fails, the bill dies. For now.

If the House adopts the rule, it can then summon the actual health reconciliation resolution to the floor for debate. A final vote will follow hours later.

And if the House approves reconciliation, it will have fulfilled its Constitutional obligation, imposed by Article 1, Section 7: “Bills for raising revenue shall originate in the House of Representatives.”

Only then may the Senate start its reconciliation debate. Probably next week if all goes well in the House.

But it all has to start with the House Budget Committee today at 3 pm.

Be there or be square.