What A Reconciliation Bill Could Look Like

By Big Tent Democrat, Section Other Politics
Posted on Mon Dec 14, 2009 at 04:31:41 PM EST
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What should be the goal of a health bill this year? As Ezra Klein argues - to save lives. Getting people health insurance does that. Accordingly, the goal for a reconciliation bill should be to offer as much health insurance assistance as possible. There are 3 main components to the current proposal that does this. They are: (1) expansion of Medicaid eligibility; (2)expand Medicare eligibility to persons aged between 55-64 (exclusive of those who would not be eligible for the Exchange) and (3) subsidies for persons not eligible for Medicaid or Medicare to purchase private insurance. To do these things, tax increases on the wealthy have been proposed. Each of these provisions, including the revenue raisers, would not run afoul of the Byrd Rule, which requires that all provisions enacted under reconciliation be budget germane and budget neutral.

What do you risk? [More...]

The reform package that many value (this of course could be passed in another bill.) Not much of a risk imo. Handle it in a later bill. The bigger risk imo, is the Stupak Amendment, which appears to be necessary to pass a bill in the House. However, that problem can be solved by eliminating the Exchange and turning the subsidies into a tax credit for the purchase of health insurance. For some reason, no one thinks of tax credits as government spending. Here, that strange reasoning would work to our advantage. Tax credits would also qualify under the Byrd Rule.

Such a bill would be a real progressive accomplishment. Of course it is not "reform," but let's face it, reform was dropped from this bill a long time ago. Such a bill would save lives. It would ask the wealthy to help the less well off. It would be a bill worth supporting.

Speaking for me only

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What A Reconciliation Bill Could Look Like | 25 comments (25 topical)

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Congress could also pass a bill (5.00 / 1) (#2)
by inclusiveheart on Mon Dec 14, 2009 at 05:03:54 PM EST

preventing private insurers from discriminating against customers because of pre-existing conditions as a stand alone bill.

It would be very hard for the GOP to argue against such a provision if it were the only issue up for debate.

I think they should have taken this in pieces from the start. On your reconciliation proposal, BTD, I would make one change which would be to make Medicare available to everyone in the 55-64 range elidgible regardless of other insurance options. If they are going to go for reconciliation they might as well make that a winning proposition for everyone in that category and for the tax payers whose risk would be far lower if all in that group would be able to pay into it - not just the insurance company cast offs who are more than likely the sickest in that group.

FDR threatened to pack the Supreme (5.00 / 1) (#9)
by MKS on Mon Dec 14, 2009 at 05:32:55 PM EST

Court, for Pete's sake. That wasn't very nice or conciliatory or probably even constitutional.

The least the Democrats can do is at least threaten something that is actually within the Senate Rules....And, who annointed the Byrd rule with divinity anyway?

Teh Byrd Rule is law (none / 0) (#11)
by Big Tent Democrat on Mon Dec 14, 2009 at 05:36:33 PM EST

not enforceable in a court though.

We went through this discussion once before and I explained that in fact if 50 Dems, plus the VP, ruled the whole damn bill in compliance with the Byrd Rule, they could pass the whole thing.

They would never do that though.


: I don't think they would go against the (none / 0) (#13)
by steviez314 on Mon Dec 14, 2009 at 05:38:35 PM EST

Parliamentarian's ruling.
But then just be like the Republicans and fire the Parliamentarian and get a new one who will rule your way.

: Exactly (none / 0) (#14)
by andgarden on Mon Dec 14, 2009 at 05:38:50 PM EST

It Is constitutional. (none / 0) (#12)
by jeffinalabama on Mon Dec 14, 2009 at 05:36:35 PM EST

There's no part of The Constitution that requires the number of jusices to be nine. I doubt it's going to grow, though. Congress would bipartisanly let the president know that there'd be no nominees either coming forward or getting advised and consented-- just like FDR.


But, "switch in time to save nine." (none / 0) (#15)
by MKS on Mon Dec 14, 2009 at 05:42:32 PM EST

It is amazing how quickly some pols can get religion when the right force is applied.

Look at Arlen Specter--I don't think his change of heart was due to a greater understanding of the issues. He is a very bright man who just got muscled....It should be happening again today in the Senate...


Specter was always smart (5.00 / 2) (#16)
by Big Tent Democrat on Mon Dec 14, 2009 at 05:44:19 PM EST

and a weasel.

Still smart and still a weasel.

But he's our smart weasel now.


Good example of your pols-will-be-pols (none / 0) (#18)
by MKS on Mon Dec 14, 2009 at 05:50:29 PM EST

theory....


: Yep (none / 0) (#21)
by Big Tent Democrat on Mon Dec 14, 2009 at 06:02:05 PM EST

True, but I think the Supreme Court (none / 0) (#19)
by MKS on Mon Dec 14, 2009 at 05:53:27 PM EST

would somehow find that the constitutional number was nine a' la Marbury v. Madison--because they say so.

They would have to, to protect their own viability.


BTD for President (none / 0) (#1)
by pluege on Mon Dec 14, 2009 at 04:57:48 PM EST

we need someone to get something done.

All the can't do fools in the democratic party are truly irritating. The very idea of letting the likes of LIEberman, nelson and snowe dictate the nature of America is galling.

What would "tax credits" (none / 0) (#3)
by NYShooter on Mon Dec 14, 2009 at 05:10:47 PM EST

(in place of subsidies) do for the working poor who pay no taxes, yet are inneligible for medicaid?

No such population (none / 0) (#4)
by Big Tent Democrat on Mon Dec 14, 2009 at 05:12:53 PM EST

BTD, unless there have been changes, (none / 0) (#8)
by jeffinalabama on Mon Dec 14, 2009 at 05:28:34 PM EST

since medicaid is a state/federal cooperation, a lot of folks hae been cut out that pay no taxes, haven't they? I'm thinking of folks in Mississippi about four years ago dropped from misscare, or whatever it's called, and the folks in tennessee who were dropped at about the same time, possibly a year earlier. Some 10 years ago I had a roommate in arizona-- no she wasn't eligible for food stamps, but ACCCS (arizona's cost containment system)did cover her for her bipolar meds.

I might just not remember correctly, but I thought there were adult working poor who fall through the cracks. If you tell me I'm mistaken, I'll accept it. Not one of my areas, and I could be mistaken.


I'm thinking of it in the vein of (none / 0) (#17)
by Big Tent Democrat on Mon Dec 14, 2009 at 05:45:11 PM EST

the EITC - where you can get a tax refund above what you pay in taxes.


: got it. thanks. (none / 0) (#20)
by jeffinalabama on Mon Dec 14, 2009 at 05:54:49 PM EST

: The problem (none / 0) (#25)
by Makarov on Mon Dec 14, 2009 at 11:33:44 PM EST

is those people don't have cash on hand to purchase the insurance required to get the tax credit next March.
This was a consistent criticism I had of both Clinton's and Obama's health care plans during the primaries last year. Unless insurance companies unilaterally decide to give you a year to pay your premium, the Tax Credit approach doesn't work.

Downside (none / 0) (#5)
by MKS on Mon Dec 14, 2009 at 05:23:20 PM EST

The Republicans will cry about the Democrats abusing them and the system, abandoning the filibuster rules....They will vow revenge...the filibuster will be dead--especially when the Dems need it to derail Republican legislation in the future.

But the Republicans already went there with their "nuclear option" threat over judges....

I suppose one could argue that if Health Reform is accomplished within the filibuster rules with 60 votes, then the Republicans would need 60 to scrap it. But, not really, they would only need 50 to de-fund it....

So, reconciliation appears worth the risk, (and it is not as if the Republicans would play nice otherwise), and the upside of real reform is huge.

: I wish people would understand this (5.00 / 1) (#6)
by Big Tent Democrat on Mon Dec 14, 2009 at 05:24:45 PM EST

"they would only need 50 to de-fund it...."

Similarly, (none / 0) (#7)
by MKS on Mon Dec 14, 2009 at 05:26:14 PM EST

Could the Senate pass a Lieberman/Ben Nelson/Lincoln/Snowe-approved version with 60 votes, and then an ancillary--and later--bill with 50 votes expanding Medicare?

That would be really cool, imo.

There is no downside risk to reconciliation. (none / 0) (#10)
by steviez314 on Mon Dec 14, 2009 at 05:36:15 PM EST

The non-reconcilable parts which need 60 votes..well, if the bill doesn't split, they would still need 60 votes in one big bill.

There is only one trade-off involved: would some Republicans actually vote in favor of the 60-bill (insurance company regulation items like recission and pre-existing) since those things are pretty popular, versus would we lose any Democrats just because they don't like the reconciliation work-around.

I dunno (none / 0) (#22)
by Big Tent Democrat on Mon Dec 14, 2009 at 06:03:45 PM EST

At this point, it really does not matter.

you alwaysa sk a good question -'are there 50 for reconciliation?' I repeat my answer - I dunno - but you sure as hell do not have 60.


: I'll stick my neck out and say I think they'll get (none / 0) (#23)
by steviez314 on Mon Dec 14, 2009 at 06:11:22 PM EST

Snowe and Collins without giving up nearly as much as they would to get Joe. At least the senators from Maine are sane (and it rhymes!)

Who's going to pay (none / 0) (#24)
by Socraticsilence on Mon Dec 14, 2009 at 10:31:34 PM EST

for increased Medicaid eligibility do you suggest increasing the federal matching rates and possibly coupling them with a benefit floor- because currently with it up to state discretion up matching rates is basically the only way to encourage state participation (its the up and downside of federalism-- you have crap like Ms. and awesome things like the Oregon Health Plan).