Splitting Health Reform

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"Splitting Health Reform"


It’s been my understanding for a while now that the Senate Democratic caucus has no interest in trying to bully the parliamentarian into letting them use the budget reconciliation process to force through a health reform package that contains substantial non-budgetary elements. But this Mark Schmitt post from last week contains a valuable reminder that the non-budget elements of health reform actually tend to be the less controversial ones, indicating that you might be able to get a much more progressive bill by basically splitting health reform into component parts.

One bill, a filibusterable non-reconciliation bill, would set up the basic framework of a health insurance “exchange” on which individuals and small businesses could get insurance. It would feature an employer mandate, some kind of sad co-op, and some not-very generous subsidies. It would be subject to various kinds of regulation including the White House’s key eight points of consumer protection. It’s a bill liberals would find horribly disappointing, but you could imagine it getting sixty votes in the senate.

Then if you get that done, all you need is a second bill. At that point, changing the co-op rules to make it work like a real public option, making the subsidies more generous, expanding Medicaid, and other wholesome progressive stuff all becomes budget-relevant material that can be done through reconciliation with only fifty votes. It’s not clear at this point that the public option has fifty votes in the senate, but it’s close, and I’m reasonably certain that the votes could be found if the procedural path existed.

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