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Pelosi floats new stratagem on health care reform

Thu., Jan. 28, 2010

Budget process could pass bill by simple majority

WASHINGTON – Laying out a possible path to passing health legislation, House Speaker Nancy Pelosi said Wednesday that the House should pass the Senate’s health bill while using a separate process known as “budget reconciliation” to make changes that House members are demanding.

The politically fraught strategy might allow Democrats to salvage a version of the major overhaul of the health system that senior lawmakers pushed through the House and Senate late last year.

Because budget reconciliation requires only a simple majority in the Senate, it could enable Democrats to circumvent a promised Republican filibuster.

“Majority rule, we call it,” Pelosi told a group of columnists Wednesday.

But House and Senate leaders still have not agreed on what changes to make to the Senate bill.

Among other changes, House Democrats have demanded the elimination of a new tax on high-end “Cadillac” health plans. They also want more subsidies to help low- and moderate-income Americans buy health insurance and more aid to states to help them expand Medicaid. The Senate bill currently limits that extra aid to a handful of states, including Nebraska.

Altogether, those changes could push the cost of the bill up $300 billion over the next 10 years to close to $1.2 trillion, according to a senior Senate Democratic aide. That price tag has already been rejected by numerous Senate Democrats as too high.

Numerous procedural challenges would arise, as well, if Democratic leaders used the budget reconciliation process to modify the health bill that passed the Senate just before Christmas. It is unclear, for example, that the Senate could vote on a package of modifications before the House adopted the Senate bill, as many House Democrats want.

Senate Majority Leader Harry Reid, D-Nev., has not publicly endorsed the reconciliation approach.

At the same time, many rank-and-file Democrats, wary of public opposition to the health care legislation, have said they would prefer a new, more limited health care bill that might win some Republican support. Democratic leaders are also considering that approach.

But a growing number of supporters of a health care overhaul, including doctors, consumer groups and labor unions, have stepped up calls for Democrats to push forward with a more ambitious overhaul. So, too, has the president.

On Wednesday, Nebraska Sen. Ben Nelson, a conservative Democrat who has opposed reconciliation in the past, indicated he would not necessarily oppose a reconciliation strategy with health care.

“If I support a bill, then I will vote for it regardless of whether it takes 50 votes to pass or 60 votes to pass,” Nelson said on a call with reporters from his home state. “My position doesn’t change just because the House or Senate decides to change the process.”

Republicans used the reconciliation process to pass former President Bush’s tax cut packages in 2001 and 2003.

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