Conrad’s Budget Markup Rolls The Die On Health Care Reform

Today, Budget Committee Chairman Kent Conrad (D-ND) released his mark-up of President Obama’s budget. Conrad left space for Obama’s health care reform fund, but did not commit to a specific dollar amount. In doing so, he freed health care from the 5-year budget window and gave Congress free reign to invest an unspecified amount in reforming the health care system — so long as that investment is revenue neutral over 10 years.

Ezra Klein and Jonathan Cohn are reporting that some Democrats are interpreting Conrad’s decision as an opportunity for Congress to exert more control over the process and finance health reform sooner:

Ezra Klein: “But one Senate staffer I talked to was almost gleeful about this change. ‘Remember The Godfather,” he said, “when Sonny Corleone shows up at the tollbooth? That’s been our experience. As soon as you put something specific on the table by itself you get the Sonny Corleone treatment. You get riddled with bullets. Interest groups rush out saying you cant do this to us. The only way we can ever get through the interest group craziness is if everybody gets to see the whole of the bill and decide if they’re on or off the total proposal.”

Jonathan Cohn: “It was important that Obama put a number on his reserve fund, these people say, because his interest in making health care a priority was in doubt. That’s not the case in Congress, where the leadership has made clear its intention to move forward and the key committee chairmen have been hard at work on a comprehensive package that will, if fully implemented, eventually insure everybody while introducing changes that will ultimately make medical care less expensive. By leaving the reserve fund undefined, these sources say, congressional budgetmakers actually leave more congressional reform architects flexibility.

Indeed, Conrad’s decision to score health care reform in a 10-year budget window buys more time for “initial investments in system reform” to “pay themselves off.” A five-year budget window would have made health reform impossible. Similarly, by dismissing Obama’s revenue sources, Conrad gives Congress more flexibility to identify a broader set of off-sets and savings in order to finance reform.


But the senator’s decision to place a big undefined X on the face of the health care reserve fund also burdens Congressional reformers. Had Conrad allocated Obama’s $634 billion (or any other amount) — which the CBO found to be revenue neutral — the Congressional committees with jurisdiction over health care would have had to spend $634 billion (over 10 years) on reform. We would have been half the way there. But by allocating an undefined amount, Conrad is rolling the die: theoretically, Congress could now spend more than $634 billion on health care — provided that it can pay for all of it — but it could also end up spending less, a lot less.

So if Obama’s initial allocation provided the comfort of commitment (in other words, we won’t have everything but at least we’ll have something), Conrad’s approach not only passes the buck on financing health care reform, but it may also ultimately jeopardize the effort.