Health-Care Reform This Week: A Tour of the Sausage Factory

No matter how interesting you've found the health-care-reform debate over the last year, even if you've been endlessly fascinated by the intricacies of subsidies and actuarial values, brace yourself for a few days of procedural bamboozling. We're entering the most bureaucratic phase of the process so far. And when it comes to this bill, that's saying something ... Here's a basic rundown of what will likely happen.

Today the House Budget Committee approved the use of the budget-reconciliation process to vote on the health-care bill that the Senate passed late last year. However, they haven't approved any specific language. They essentially said, OK, we will let the House make fixes to the Senate bill. That means that House Democrats will be able to strip out of the Senate bill all the things they don't like, including the "Cornhusker Kickback" and the carve out for Florida seniors, and enhance the things they do like, including making the subsidies to help poorer people purchase insurance more generous.

But at this stage, we still don't know specifically what they will do because they haven't released the contents of the reconciliation bill itself. The budget committee approved what they call a "shell" bill, which will now go to the Rules Committee. This second committee is the all-powerful group that decides what can and can't be discussed on the House floor and what the rules of debate are (that is, which amendments can be offered, how long debate can go on for etc.) Democrats have a clear majority on the Rules Committee (9 Ds to 4 Rs) and Pelosi is careful to ensure those who sit on the Rules Committee are on her side. So, there's little doubt that the Rules Committee will allow the budget-reconciliation bill, which contains all the health-care fixes, to progress to the floor, where it will (finally!) get an up or down vote.

With me so far? If you haven't fallen asleep yet, there's a couple of other things you should know. First, there is a two-calender-day waiting period between when the Budget Committee approves the reconciliation bill and when the Rules Committee can consider it. So that means the Rules Committee can't recommend the bill to the House floor until Thursday.

In addition, House Democrats took a pledge a few years back—one they have upheld ever since—that they would allow a 72-hour period between when a bill is posted online and when the House can vote on it. So, because we don't know what the reconciliation bill actually looks like yet, we only know that the use of a reconciliation bill has been approved, the 72-hour waiting period means the House won't be able to vote until Thursday night at the absolute earliest. And that's assuming Democrats will post the bill's language tonight, which I'll bet they won't. What's more likely is they will post the language sometime Tuesday, which means the full House can't vote the health-care-reform fixes until Friday. If they do pass a bill on Friday, President Obama can sign health-care reform into law before he jets off to Australia and Indonesia on Sunday.

But wait, you ask, this whole post has only been about the reconciliation bill. Doesn't the House have to actually pass the Senate bill first? Aha! I'm glad you asked. Technically no, the House does not have to pass the Senate bill and then vote on the changes by using the reconciliation process. Nancy Pelosi indicated this morning that she'd be prepared to use a technique where, in passing the fixes to the Senate bill, the House "deems" that bill to have passed. They don't have to take a separate vote on the Senate bill itself. That way, the president can still sign the Senate bill into law once the House has passed the reconciliation bill because once the House votes in favor of the fixes in the reconciliation bill, it's effectively saying the Senate bill has passed as well.

Got it? Easy as pie.

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