Health Care Reform Within Our Grasp, But Barely

This week Ceci Connolly reported for the Washington Post about a medical crisis in North Carolina. Double-digit unemployment has pushed up the rate of state residents without health insurance to over 25 percent.

Nationally, every 1 percent increase in the unemployment rate translates into 1.1 million people losing their health insurance. Even though they may be eligible to purchase group rate insurance through COBRA, the cost of even group plans is so high that the unemployed often cannot afford it.

But it isn’t just the unemployed who go without insurance. Earlier this year Cara Buckley of the New York Times reported on young working people in New York without health insurance: “They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones.”

People — often people who have worked and paid taxes for many years — are suffering for lack of basic health care in what is supposed to be the wealthiest nation in the world. This is insane. If other nations can provide 21st century health care for all citizens for less money per capita than we are paying now, why can’t the United States?

In fact, we can do it if we have the will to do it. And the will to do it has to be found in Congress. The biggest stumbling block is in the Senate.

A health care reform bill needs the votes of 50 senators (plus Vice President Biden, in case of a tie) to pass. Even if no Republicans vote for health care reform, which is likely, there should be 50 Democratic votes to pass a bill. So what’s the problem?

The problem is that under usual Senate rules, it takes the votes of 60 Senators to close debate and actually vote on a bill. Thus, the 41 Republicans in the Senator can filibuster away and stop the bill from passing. And Senate Republicans are being very clear that’s what they intend to do.

There is a way around this stumbling block, called the reconciliation process. Congress can add language to the budget bill that instructs a particular committee to produce certain a bill with specified spending targets. The committee sends the bill back to the Budget Committee, which makes the bill part of an omnibus bill. The omnibus bill gets 20 hours of debate and then is voted on by the full Senate. Conventional wisdom says this is the only way a health care reform bill is going to make it out of the current Senate.

So, by way of byzantine congressional rules, the road to health care reform goes the budget bill. The House version of the congressional budget resolution contains the reconciliation language; the Senate version of the budget resolution does not.

Senate Republicans are in whining overdrive about being deprived of the filibuster, even though they frequently used the reconciliation language to forward their legislative agenda from 2003 to 2006, while they were in the majority. In fact, some tried to end the filibuster altogether for judicial nominations in 2004 and 2005. Now, suddenly, some of these same senators speak of the filibuster as the last bastion of civilization and democracy.

This week Senator Edward Kennedy signaled that work on health care reform is about to begin in earnest. Health care reform surely will be welcome by uninsured Americans with mesothelioma and other asbestos-related disease. But we’re going to have quite a fight on our hands to get it passed.

Barbara O’Brien
April 21, 2009

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