The role for reconciliation

Reconciliation is not being considered for passing comprehensive health-care reform. Major health-care reform legislation passed the Senate without reconciliation on Christmas Eve. If the House now passes that legislation, it can go immediately to President Obama's desk to be signed into law. What the president and others have suggested is that, after the House acts, reconciliation could then be used to pass a much smaller "fixer" bill to allow for modifications to the comprehensive bill that will have passed under regular order.

While some have described reconciliation -- a process that requires only a majority vote in the Senate to pass legislation that reduces the deficit -- as an obscure, rarely used procedure, the truth is that it has been used 22 times since 1980, with 16 of those times occurring when Republicans controlled the Senate. Republican efforts to block its use now for a "fixer" bill represent little more than a politically expedient attempt to kill health-care legislation.

Since health-care reform re-emerged on the national agenda more than a year ago, I have consistently said that comprehensive health reform cannot be achieved through reconciliation. The reconciliation process was never intended for comprehensive policy changes. The Senate parliamentarian concluded that if legislation such as health-care reform were to go through the reconciliation process, it would come out looking like "Swiss cheese." Some of the most significant portions of the legislation, such as insurance market reforms and delivery system reforms, might have to be dropped.

Even if implemented only as a "fixer" bill, reconciliation could still be used only for changes that are truly budget-related -- meaning they affect revenue or spending. Changes to improve the affordability of health care or adjust the amount of federal aid going to states for Medicaid could be good candidates for a reconciliation bill. But changes involving strictly policy matters, which do not have a budgetary impact, would likely have to be addressed some other way.

This "fixer" reconciliation bill would also still have to meet the requirement that reconciliation be used only for deficit reduction. In fact, the bill would have to include at least $2 billion in deficit reduction over the first five years and would have to be at least deficit-neutral in every year beyond that.

Some question how the then-Republican majority used reconciliation to pass a $1.3 trillion tax cut in 2001 and another $350 billion tax cut in 2003, all entirely unpaid for. These were clear abuses of the process. The authors of the Congressional Budget Act of 1974, which established reconciliation, never envisioned it would be used to worsen the deficit. After Democrats took control of the Senate in 2007, we restored fiscal discipline and added an explicit rule requiring reconciliation be used only for deficit reduction. So it is particularly ironic to hear many Republicans criticize Democrats' use of reconciliation today, when it is being used properly, while they vehemently defended their use of the process when it was being abused.

The truth is, the Senate has already passed a responsible health-care reform bill with 60 votes that will expand coverage, lower premiums, improve quality and control costs. And most important, the Congressional Budget Office estimates it will reduce the deficit by $130 billion over the first 10 years and by as much as $1.3 trillion over the second 10 years. This represents a significant step in the right direction. If the Senate bill can be further improved with changes made through a small "fixer" reconciliation package, we should do so. Those who argue against its use in this context seek only to protect the status quo on health care.

The writer, a Democrat, is a U.S. senator from North Dakota.