Sen. Orrin Hatch (R-UT) has penned a fairly disingenuous editorial in today’s Washington Post, attacking Democrats for considering the reconciliation process to pass health care reform. “This use of reconciliation to jam through this legislation, against the will of the American people, would be unprecedented in scope,” Hatch claims:

Reconciliation was designed to balance the federal budget. Both parties have used the process, but only when the bills in question stuck close to dealing with the budget. In instances in which other substantive legislation was included, the legislation had significant bipartisan support.

Hatch argues against a straw man. As Sen. Kent Conrad (D-ND) — who Hatch quotes as an opponent of reconciliation — explained this morning on MSNBC, Democrats are planning to use reconciliation on a smaller package of changes that effect the budget, not the entirety of reform, as Hatch suggests.

“On Christmas Eve, the Senate passed, without using reconciliation, by a super majority, 60 votes, fundamental health care reform.” “That package, as I said, now goes to the House. If the House passes it, goes to the President for signature, without reconciliation ever having been used. Now, again, the House could then pass a package to improve the health care reform with matters that are only budget related. That was the whole intention of reconciliation, that it only be used for budget-related matters and that would be absolutely consistent with how reconciliation has been done, by both Republicans and Democrats.”

Hatch’s claim that “substantive” reconciliation legislation had “significant bipartisan support” is also wrong. Some reconciliation packages did attract bipartisan support, but lawmakers have used reconciliation precisely because their bills could not attract 60 votes. Hatch has voted for 12 of the last 14 reconciliation bills since 1989, including President Bush’s non-partisan budget busting tax cuts (those effected 100% of the economy and cost $1.8 trillion). (Hatch’s votes are designated with a *.) Check out this table compiled by DC Progressive’s Emma Sandoe:

	Vote Count	Bipartisan support?
College Cost Reduction and Access Act of 2007*	79-12-9	Yes, although all 12 voting against it were Republicans
Tax Increase Prevention and Reconciliation Act of 2005*	54-44-2	3 Democrats (Nelson (D-NE), Nelson (D-FL), Pryor (D-AR)) voted for it
Deficit Reduction Act of 2005*	52-47	2 Democrats (Landrieu (D-LA) and Nelson (D-NE))
Jobs and Growth Tax Relief Reconciliation Act of 2003*	50-50	2 Democrats (Nelson (D-NE) and Miller (D-GA)) voted for it
Economic Growth and Tax Relief Reconciliation Act of 2001*	58-33-2-7	Yes
Marriage Tax Relief Reconciliation Act of 2000*	60-34-5	Yes
Taxpayer Refund and Relief Act of 1999*	50-49	Yes, 3 Democrats (Breaux (D-LA), Landrieu (D-LA), Torricelli (D-NJ)) voted for it
Taxpayer Relief Act of 1997	92-8	Yes
Balanced Budget Act of 1997*	85-15	Yes
Personal Responsibility and Work Opportunity Act*	74-24-2	Yes
Balanced Budget Act of 1995*	52-47	Yes
Omnibus Budget Reconciliation Act of 1993	49-49-2	No
Omnibus Budget Reconciliation Act of 1990*	54-46	Yes
Omnibus Budget Reconciliation Act of 1989*	87-7-6	Yes

Steve Benen also takes on Hatch’s argument that Republicans chose to pass the Medicare prescription drug bill through regular out of respect for the Senate’s rules. “What Hatch conveniently forgets is that reconciliation wasn’t used when Republicans expanded Medicare (without paying for it) because Democrats didn’t filibuster the final bill. The GOP didn’t skip majority rule because of the goodness of their hearts; the Republican majority skipped it because they didn’t need it,” he writes.

President Obama has written a letter to Congressional leaders outlining the areas of agreement between Democrats and Republicans on health care reform. Obama also listed at least four Republican ideas that he wants to include in the package of fixes he is expected to unveil tomorrow afternoon.

Obama’s proposals are mild in nature and are unlikely to please start-over Republicans or offend progressive Democrats. The four ideas strengthen bipartisan provisions that are already part of Obama’s proposal and the Senate health care bill. The big ticket item is Obama’s support for increasing Medicaid rates to Medicare levels. That provision, which was included in the House health care bill, could cost north of $57 billion over 10 years and will certainly catch the eye of the American Medical Association and generate praise from both Democrats and Republicans:

1. Undercover waste/fraud/abuse investigations: “Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.” EXISTING PROVISIONS: Obama’s plan invests in a Comprehensive Sanctions Database, expands access to the Healthcare Integrity and Protection Data Bank, among other provisions. The Senate bill also invests in preventing fraud, waste and abuse.

2. Additional grants to states for tort reform: “I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants.” EXISTING PROVISIONS: The current legislation already authorizes demonstration projects.

3. Increasing Medicaid reimbursement rates: “At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states…I’m open to exploring ways to address this issue in a fiscally responsible manner.” EXISTING PROVISIONS: The House health care bill gradually increased Medicaid reimbursement rates up to Medicare levels, but the Senate legislation did not include this provision.

4. Strengthen high deductible provisions: “I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear.”
EXISTING PROVISIONS: The current Senate bill allows young Americans to enroll in high deductible coverage and the exchange also offers so-called bronze-level plans that charge higher deductibles and co payments but offer lower premiums. Bronze policies would have to cover the “essential benefits” specified in the legislation and would likely be more comprehensive than policies available in the existing nongroup marketplace. The catastrophic plans for high adults would be required to offer preventive coverage at no cost sharing.

While the whole of the latter is rather expected, I’m surprised that Obama didn’t make stronger concession on tort reform. While in the Senate, Obama co-sponsored “legislation aimed at reducing both medical errors and lawsuits through a program known as Sorry Works, rooted in the idea that injured patients value an apology as much as money.” That legislation would have given physicians who disclosed their errors “certain protections from liability within the context of the program, in order to promote a safe environment for disclosure.“

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Inside Health Policy has obtained a Democratic memo that lays out a timeline for passing the Senate health care bill in the House alongside a package of fixes using reconciliation. Hoping to avoid the disastrous August recess town halls, Democrats are going to try and finish reform before members go home for the Easter break at the end of March. The hard deadline and pending vacation could pressure reluctant Democrats to vote ‘yes’ in the House and help Democrats move on to jobs and the economy as they enter the election season. Here is the rough outline:

1. March 3: President Obama lays out the path forward for health care reform and unveils a smaller package of fixes that will bridge the difference between the House and Senate health care bills.

2. March 4-19: Summary of the president’s proposal will be turned into legislative language. House and Senate leaders will begin looking for votes.

3. By March 19: The House passes the Senate’s health reform. The bill then goes to the president for signature without going through conference. Senate Democrats will make some kind of assurance to House leadership that they will pass a package of fixes through the reconciliation process.

4. By March 21: The House amends the Senate bill through a reconciliation bill.

5. By March 23: The Senate begins debate on the reconciliation bill. Debate is limited to 20 hours.

6. Votes begin March 26, the first day of Easter recess, at which point Reid announces that the Senate will stay in session through recess to consider all amendments.

7. Before March 29: Vote on final passage follows consideration of the last amendment. The reconciliation bill will have to go into conference with the House. The goal is to pass health reform before the Spring recess (March 29-April 9).

The timeline is incredibly tight and will require Democrats to move quickly in convincing reluctant members to support Obama’s package of fixes and reassuring skeptical House Democrats that the Senate has the votes to pass his package. But first, Obama will have to appease progressive Democrats while simultaneously retaining more moderate Democratic votes. The package will have to invest more money in affordability affordability standards, move up the excise tax thresholds and close the Medicare part D donut hole, all while containing the cost of the legislation and ensuring enough deficit reduction. It’s a tough haul considering that Democrats might also have to rely on Vice President Joe Biden to incorporate an abortion compromise in the reconciliation package if they hope to hold on to Stupak’s pro-lifers.

Democrats will also have to withstand the GOP’s strategy of offering hundreds, if not thousands of amendments after the initial 20 hours of debate. As Roll Call reports today, “Republicans believe these tactics could tie up the Senate floor for several weeks and force Democrats to take multiple votes that would be difficult to defend in the midterm elections.”

If Democrats decide to pursue a reconciliation strategy, as most observers and lawmakers believe they will, they should expect to come out a bit scarred on the other end. But then again, that’s their only alternative. If Democrats use reconciliation, Republicans will undoubtedly attack Democrats for ‘jamming through’ unpopular legislation. If they don’t, Republicans will attack Democrats for voting for unpopular legislation in 2009. Even worse, voters will resent Democrats for abandoning reform and succumbing to the process of Washington.

Consider that the Democrats’ Easter offensive may be the very last opportunity for passing comprehensive reform for the next 15-20 years, the battle is worth the political sacrifice. The odds of success are unknown, but if there is one thing we learned from the health care debate it’s that you never know if you have enough votes until the clerk reads the roll.

Sen. Jeff Bingaman (D-NM) refused to predict the odds for health reform passing Congress, but told C-SPAN’s Washington Journal this morning that lawmakers would have to use reconciliation “if health care is to pass.” “We’ve passed a lot of major legislation through the reconciliation process in the past and this would be another example of that”:

CSPAN: You said you’re not sure it would pass. Can you give our viewers an idea of the likelihood that this might pass?

BINGAMAN: Well, I can’t frankly, I think the real determination will be made in the House of Representatives. The House, of course, has a very narrow margin of folks who have supported this bill and a few of them are no longer there, the ones who voted for it last year and the question is can they get enough votes in the House to go ahead to pass a series of changes to the Senate passed bill.

Watch it:

Asked to respond to Sen. Orrin Hatch’s (R-UT) Washington Post editorial claiming that reconciliation should only be used on “legislation that commands broad, bipartisan support,” Bingaman conceded that some past reconciliation bills like CHIP attracted bipartisan support but argued that lawmakers had to use the process precisely because their bills could not attract wide bipartisan support.

“There was bipartisan support, there is no question for those, but there were not 60 votes for those,” he said. “The real issue is, are you going to use reconciliation in order to pass something with a majority in the Senate — there has to be a majority in favor — or are you not? And I agree that there had been other bills that passed as part of reconciliation that had some bipartisan support, but they do not have 60 votes.”