The ACP Advocate Blog
by Bob Doherty
Thursday, March 4, 2010
Reconciliation (n), rapprochement, the reestablishing of cordial relations
This is one definition of reconciliation, but yesterday's announcement by President Obama that he will pursue final enactment of health reform on a simple majority vote, likely using a parliamentary procedure called reconciliation, will have the opposite effect on relations between Republicans and Democrats.
Yesterday, ACP was invited to the East Room of the White House to hear President Obama's remarks on a way forward on health care reform. Dr. Fred Ralston, ACP's president-elect, was invited to sit in the first row, facing President Obama. (You can see Dr. Ralston and President Obama together and shaking hands in video clips from the White House and C-SPAN. Dr. Ralston is the one wearing a lab coat with the ACP logo. He was accompanied by Dr. Fred Turton, the chair of the Board of Regents; Dr. John Tooker, Chief Executive Officer and Executive Vice President; and me.)
Here is how the President explained the key elements of his proposal:
"First, it would end the worst practices of insurance companies. No longer would they be able to deny your coverage because of a preexisting condition ... to drop your coverage because you got sick ... to force you to pay unlimited amounts of money out of your own pocket ... to arbitrarily and massively raise premiums ...
"Second, [it] ... would give uninsured individuals and small business owners the same kind of choice of private health insurance that members of Congress get for themselves ... The reason federal employees get a good deal on health insurance is that we all participate in an insurance market where insurance companies give better coverage and better rates, because they get more customers ... if you still can't afford the insurance in this new marketplace ... then we'll offer you tax credits to do so - tax credits that add up to the largest middle-class tax cut for health care in history.
"Finally, my proposal would bring down the cost of health care for millions -- families, businesses, and the federal government. We have now incorporated most of the serious ideas from across the political spectrum about how to contain the rising cost of health care ..."
The above policies generally are consistent with ACP's own proposal to expand access to care, and most already are included in the bills passed by the House and Senate.
In a separate letter the President offered to consider four ideas popular in Republican circles: increased emphasis on eliminating fraud, expansion of health savings accounts, increased funding of state programs to test alternatives to the current tort system including health courts, and increased Medicaid payments to physicians.
The big news of the day - but not really unexpected - was that President Obama called for Congress to take the final steps using a complicated and controversial procedure, called reconciliation, which would allow for changes in the Senate-passed bill to be made on a simple majority vote:
"Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of 60 votes. And now it deserves the same kind of up or down vote that was cast on welfare reform, that was cast on the Children's Health Insurance Program, that was used for COBRA health coverage for the unemployed, and, by the way, for both Bush tax cuts --- all of which had to pass Congress with nothing more than a simple majority. I, therefore, ask leaders in both houses of Congress to finish their work and schedule a vote in the next few weeks."
Republicans responded by expressing outrage and vowing to do everything possible to block a reconciliation vote.
The reconciliation process will be ugly and polarizing, although it is hard to see the country being any more divided than it is right now. ACP has no control over the process used to pass legislation, but what we can do is to continue to work to achieve enactment of legislation that includes our key priorities on coverage, workforce, physician payment, and medical liability reform.
The next few weeks will be the endgame for health reform. It will either pass, with the final changes made on a partisan basis using a simple majority vote. Or it will be defeated, and health care reform likely will be dead for years to come. The outcome remains in doubt, but Marc Ambinder, an experienced Washington observer, now believes that events have shifted in reform's favor. We'll see.
Today's question: What do you think about yesterday's remarks by the President and his plan to push Congress to make the final changes using a simple majority vote?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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