Health Care and Reconciliation? They Go Way Back!

Julie Rovner from NPR is out today with a fascinating history of health care and the budget-reconciliation process in the Senate. She shows how every major health-care innovation of the last three decades has been done through reconciliation. One of her best examples is COBRA, that vital and popular law that allows people to keep their health insurance for a period after they've lost their job. The acronym actually stands for the reconciliation bill that established the program: the Consolidated Omnibus Budget Reconciliation Act of 1985. The Children's Health Insurance Program—which, together with Medicaid, gives one third of all American children access to health care—was also done via reconciliation. It's hardly the dastardly procedure some in Congress would have you believe it is. Here's Rovner:

"The use of expedited reconciliation process to push through more dramatic changes to a health care bill of such size, scope and magnitude is unprecedented," Sen. Orrin Hatch (R-UT) wrote in a letter to President Obama on Monday, urging him to renounce the possibility of trying to pass a bill using the procedure.

"But health care and reconciliation actually have a lengthy history. "In fact, the way in which virtually all of health reform, with very, very limited exceptions, has happened over the past 30 years has been the reconciliation process," says Sara Rosenbaum, who chairs the Department of Health Policy at George Washington University.

"... 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 And one of those—the 1988 Medicare Catastrophic Coverage Act — was repealed the following year after a backlash by seniors who were asked to underwrite the measure themselves.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."

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