President Obama's Health Care Strategy: Reconciling or Ramming?

WASHINGTON (March 4) -- Call them irreconcilable differences.

President Barack Obama's signal Wednesday that he is done with bipartisanship if it means health care reform is a goner is shining a spotlight on the arcane process known as "budget reconciliation." Not that many here like to use such wonky terms for the maneuver to bypass a Senate filibuster.

In his speech designed to "bring this journey to a close," the president said health care "deserves the same kind of up-or-down vote that was cast on welfare reform, the Children's Health Insurance Program, COBRA health coverage for the unemployed and both Bush tax cuts -- all of which had to pass Congress with nothing more than a simple majority."

Sen. Lamar Alexander of Tennessee called the measure by its name in his opening statement for Republicans at last month's health care summit at Blair House. "My request is this," he said, "that the Democratic congressional leaders and you, Mr. President, renounce this idea of going back to the Congress and jamming through on ... a partisan vote through a little-used process we call reconciliation your version of the bill."

Democrats haven't obliged. But they have pointed out that reconciliation is hardly "little used" and often has been employed by Republican administrations.

Congress has passed 22 reconciliation measures since 1980, according to the Congressional Research Service. Three of those bills, written by Republican-controlled Congresses, were vetoed by Democratic President Bill Clinton. The other 19 were signed into law. They include such major legislation as:

Welfare reform, which rewrote and tightened the rules for getting public assistance
The Bush tax cuts of 2001 and 2003, as well as their extension in 2005
COBRA health coverage for laid-off workers (the "R" in the acronym stands for "reconciliation")
The Children's Health Insurance Program

Reconciliation has been used to tweak the tax code, as when it was deployed to eliminate the "marriage penalty." It's also been used to create federal standards for nursing homes, adjust student loan interest rates, change Nuclear Regulatory Commission fees and auction licenses to use the electromagnetic spectrum.

Some of the most common uses of reconciliation have been related to health care. Changes in Medicare and Medicaid eligibility, veterans' medical care, hospital payments, maternal and child health block grant programs, and self-employed health insurance have been addressed using the budget procedure. Indeed, health care and reconciliation have a long history together.

Those on the right aren't buying the "reconciliation is routine" argument, though.

"Unprecedented" was the headline on a National Review article by Michael Franc, a congressional expert at the conservative Heritage Foundation. He wrote of the measure that there is "no precedent for using it to enact a once-in-a-generation rewrite of the relationship between Americans and their government that appeals exclusively to one side of the aisle."

In an interview with AOL News, Franc noted that since World War II every major piece of legislation -- civil rights, the creation of Medicaid and Medicare, NAFTA, the Patriot Act -- has passed on a bipartisan vote. "It's a river boat gamble of the highest proportions," he said of Democrats' intention to forge ahead without the minority party.

The Wall Street Journal railed against an "abuse of power." It even cited Sen. Robert Byrd, the West Virginia Democrat who helped write the reconciliation law and has written a four-volume history of the Senate. Byrd wrote in The Washington Post that using a process intended for deficit reduction to enact substantive policy changes "is an undemocratic disservice to our people and to the Senate's institutional role."

Norman Ornstein, a congressional expert at the American Enterprise Institute, called Republican rhetoric "nonsense." He has written that reconciliation hardly amounts to a power grab. "The argument is bogus but will be repeated and repeated and repeated by Republicans," he said. "It doesn't matter whether it's true or not."

Those on the left -- including Obama -- weren't always fans of the measure. There was some hand-wringing last spring when the idea first was discussed. But now Democratic partisans have warmed to the idea, especially amid Republican vows to campaign for repeal of the bill even before it passes.

Rutgers University congressional expert Ross Baker said the "hysteria" over reconciliation by Republicans is disconnected to the reason it was included in the Congressional Budget Act of 1974 in the first place. It was designed to blunt the politics of dealing with revenue, spending and deficit issues in a Congress where "few have the courage" to make tough decisions.

Reconciliation, Baker noted, "was supposed to happen every year."