Democrats Eyeing Split Health Reform Strategy



A 50 vote Senate gets you a better health care bill than a 60 vote Senate. A 50 vote Senate makes a public option more likely. And more important, it makes a good public option more likely. It makes generous subsidies more likely. It makes serious Medicaid expansion more likely. But to get a 50 vote Senate you need the “budget reconciliation” process and it seems that the Senate Democrats are unwilling to force the sort of procedural rulings that would make it possible to create an exchange and set up new insurance regulations. As I pointed out a few days ago one way around that is just to split the bill.

Have the Finance Committee report out two bills. One a filibusterable, regulation-focused bill to create health insurance exchanges and set up a skeleton of reform and the other a non-filibusterable bill focused on raising taxes and disbursing funds on subsidies, public program expansions, and setting up a new public plan with up-front costs but long-run savings. Pass the moderate bill one week, let everyone go home to their constituents for a weekend and brag about how bipartisan they are, then come back next week and pass the more progressive bill with fewer votes.

The Wall Street Journal now reports that Senate leaders are taking a serious look at this option. And it’s a good idea. Still, it is worth emphasizing that no level of procedural cleverness can substitute for actual desire to pass legislation. If moderate Democratic senators just don’t want to cast a “yes” vote in favor of progressive health legislation, this lets them have their way and still pass a good bill. But if Max Baucus and Kent Conrad are actually fanatically devoted to defending the interests of the for-profit health care industry, then he can find ways to make this not work. Which is to say that insofar as procedural obstacles are really about procedure then the obstacles can be overcome, but if key congressional actors just won’t stomach a progressive bill then only the threat or reality of them losing an election will change things.