Reconciliation Commonly Used For Health Care–Not The Nuclear Option

Despite the talk that health care reform is dead, the Democrats have at least a 50:50 chance of passing the Senate bill and fixing it by use of budget reconciliation. Republicans are trying to counter this by falsely claiming this would be using the “nuclear option.” Steve Benen provides a good summary of what the “nuclear option” proposed by Senate Republicans in the past really consisted of and how it differs from what the Democrats are actually considering.

Budget reconciliation has been used many times in the past to pass a variety of measures. Today NPR’s Morning Edition had a story on how reconciliation has been used to pass health care measures. This includes COBRA and creating CHIP. Reconciliation has also been used several times to make changes in the Medicare and Medicaid programs. The story concluded with a discussion of using reconciliation for changes in Medicare:

Budget reconciliation has also been an important tool for changing the Medicare program.

“Going back even close to 30 years, if you start say in 1982, the reconciliation bill that year added the hospice benefit, which is very important to people at the end of life,” says Tricia Neuman, vice president and director of the Medicare Policy Project for the Kaiser Family Foundation.

Over the years, budget reconciliation bills added Medicare benefits for HMOs, for preventive care like cancer screenings; added protections for patients in nursing homes; and changed the way Medicare pays doctors and other health professionals.

Because the point of budget reconciliation was usually to cut the deficit, the huge Medicare program was nearly always on the chopping block. But there’s another reason it became the bill of choice for other far-reaching changes.

“This happened primarily because it was the only train leaving the station, so if policymakers wanted to make a change in health policy, the only way to do it would be to amend a reconciliation bill, and that’s really why it happened,” says Neuman, a former congressional health policy staffer.

In fact, over the past three decades, the number of major health financing measures that were NOT passed via budget reconciliation can be counted on one hand. And one of those — the 1988 Medicare Catastrophic Coverage Act — was repealed the following year after a backlash by seniors who were asked to underwrite the measure themselves. So using the process to try to pass a health overhaul bill might not be easy. But it won’t be unprecedented.

It also must be remembered that similar health care bills passed the House by a majority vote and by the  Senate by a super-majority. Now all we are talking about is using a simple majority vote to make adjustments to two separate bills which have already passed in order to prepare the final bill. This is not anything which is either radical or unprecedented.

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