Federal lawmakers last week steeled themselves for a nasty fight over Medicare and Medicaid reform on Capitol Hill, with a key Senate Republican lashing out against a legislative maneuver that would make it easier for Democrats to pass a bill, but that ultimately would die at the White House.
Sen. Chuck Grassley (R-Iowa), the ranking Republican on the Senate Finance Committee, last week charged Democrats with laying the groundwork for whats called a reconciliation directive, which would essentially allow legislation to be approved on a simple majority vote in the Senate rather than the usual 60-vote majority that Democrats likely could not muster. In a pre-emptive strike lobbed from the Senate floor, Grassley said such a move would serve only to isolate Republicans and would ensure a veto from President Bush.
The bottom line is that reconciliation is a bad idea, Grassley said. Its partisan; it wont become law. We have serious work to do before the end of June, and a sham political reconciliation exercise is not getting us any closer to getting it done.
A Bush veto would likely cinch that congressional priorities such as a long-term physician-payment solution, Medicare Advantage reforms and an extension of a popular childrens health insurance plan would not happen this year, kicking it over to a new administration instead.
Nevertheless, the maneuver could prove to be a strategic winner for Democrats, who would force Bush into vetoing legislation that many consider popular right before the presidential elections, said Joseph Antos, a health policy analyst at the American Enterprise Institute for Public Policy Research in Washington.
The Democrats in the House can mostly play for publicity, not for policy, Antos said.
Grassley made his statement just as both parties traded barbs over healthcare spending during congressional debates on two separate budget resolutions. The House and Senate late last week each passed fiscal spending blueprints that would allow upward of $3 trillion for domestic programs, including Medicare and Medicaid, while flatly rejecting President Bushs call for steep cuts to those programs.
Both budgets contain legislative placeholders that make it easier for members of Congress to approve future spending for health information technology, an expansion of the State Childrens Health Insurance Program, physician Medicare payments and more. The House approved its fiscal 2009 budget by a 212-207 vote; the Senate passed by a 51-44 count, with the three Senators who are presidential candidates returning to the Capitol to vote.
Additionally, the resolutions would also allow for Congress to put a stop to a series of Medicaid regulations that have been widely panned by state governors who fear a lack of federal funding.
Now, the two chambers have to meld both resolutions together. While the final product is nonbinding, it does provide lawmakers with a road map of their legislative priorities over the balance of the session. It sends a signal as to the intent of Congress of where they want to go, said Tom Nickels, senior vice president of federal relations at the American Hospital Association.
The House budget calls for the Ways and Means Committee to draft a reconciliation bill that would produce $750 million in savings. Under reconciliation, a committee must file a bill that includes at least some measure of program cuts as a means to balance the budget. All that means is that the final bill has to save $750 million, Nickels said.
But the process also is used to provide political cover. In this instance, reconciliation would make it easier for the Senate to pass a whole range of Medicare provisions, some of which were included in the House-passed Childrens Health and Medicare Protection Act of 2007. That bill got whittled down by the Senate to almost nothing last year. If the reconciliation order survives when the bill goes over to the Senate, then the Finance Committee would also have to follow the same rules, Nickels said.
The process is a double-edged sword. On the one hand, it allows for Democrats, who hold a slim majority in the Senate, to more quickly move and pass legislation with limited input from the Republicans. The flip side, however, is that process would require cuts to other programs.
The presence of reconciliation in the Senate would make it easier or more likely that the Senate can pass a Medicare bill, Nickels said, something that the AHA wants. But since the process would require some cuts, he added that the AHA would work to try to ensure that it doesnt come at the expense of hospitals.
The statement comes at a time when the Senate is haranguing over a Medicare bill that at the very least would hold off a Medicare physician pay cut this year, and as both houses are hammering out budgetary line items. Grassley said that the use of the reconciliation process would delay such legislation.