During the health care debate Democrats worked very hard to promote the myth that reconciliation is an incredibly limited legislative procedure. They did this to create an excuse so they could tell their base the rules “forced” them to go with a corporatist health care reform package. In reality Democrats didn’t pass a more progressive law, because they didn’t want a more progressive law.
Yet this absurd myth has become so ingrained with the Democrats’ defenders in the health care battle they actually believe it. They now use the lies this Democratic myth was built on to claim a President Romney, if the Republicans won a majority in the Senate, would have a lot of trouble repealing the Affordable Care Act using reconciliation. We have seen this general idea from both Jon Chait and Sarah Kliff. The simple truth is that if Romney and a Republican Congressional majority really wanted to repeal the law with reconciliation, they could do so very easily.
To begin with, the reconciliation process is governed by the “Byrd Rule” (PDF). The most important aspects of the rule state that provisions in a reconciliation bill most change outlays or revenues, and the entire bill must be deficit reducing over the long term. Applications of the rule are also nominally subject to interpretations by the Senate Parliamentarian.
While the Senate Parliamentarian’s advice is usually, but not always, followed, the position has no actual power. The important thing to know is that the only persons empowered to determine what the Senate rules actually mean and whether a provision follows the Byrd Rule consist of a simple majority of sitting Senators. If necessary the majority of Senate Republicans can determine the rules mean whatever the GOP majority want them to mean. And that majority could pass a bill to repeal the whole law.
Ignoring Senate traditions regarding reconciliation would be nothing new for Republicans. They did it when they passed the Bush tax cuts even though the procedure was supposedly meant to reduce deficits.
Most likely, though, the Republicans won’t even need to reinterpret Senate rules or break traditions to repeal almost all of the ACA. Despite what some writers claim, the Byrd Rule isn’t narrowly limited by provisions about directly changing taxes or providing direct funding.
For example, Kliff goes so far as to make the absurd claim that repealing the fine that is supposed to enforce the individual mandate wouldn’t meet the Byrd Rule requirement of changing revenue. But a direct fine clearly falls under “changing revenue,” as demonstrated by the fact that Democrats modified the fines with their reconciliation bill. She also falls into the fallacy of assuming that each and every provision must be deficit reducing; but a reconciliation bill can have deficit increasing provisions as long as the whole bill reduces the deficit.
Most policy changes will impact revenues or outlays. For example since employer-provided insurance is tax exempt, almost any major health insurance regulation could be scored by the CBO as producing a change in revenue. Better insurance means less tax revenue. As a result the GOP could legitimately argue that repealing many of the ACA provisions would meet the Byrd Rule. And the Senate majority would, after all, be the final judge of want is a legitimate argument. The GOP will be able to point to the fact that even the reconciliation bill passed by Democrats included some new health insurance regulations.
Making a whole repeal bill deficit reducing simply requires a similar trick to what the GOP did to make the Bush tax cuts qualify for deficit reduction. The GOP could, for example, have the reconciliation bill appear to implement a beefed up version of the excise tax at the end of 10 years, knowing no future Congress would allow the tax to take effect.
If the Republican party wins control of the government, and they are determined to repeal the Affordable Care Act with reconciliation, they can. If necessary, they can do it by heavily bending Senate traditions. But it is likely they could achieve most of their repeal goals even without needing to use extreme hardball tactics. Democrats sought to deceive their base by insisting reconciliation is extremely limited, but that doesn’t mean it is true.





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That about says it all. So the super majority rule should go. As for the ACA, someone needs to make up my mind.
Haven’t yet read the post, but the photo is priceless.
Jon, well written.
I think a lot of people don’t stop to think of the fire they play with regarding the 60 vote rule.
Yeah, it prevents some stuff you might want passed from getting passed, but it also prevents a number of things you DON’T want repealed from being repealed.
There is no question that the GOP, who at some point will regain the Senate majority, as happens from time to time (about 16 years of the past 31 years), would use a majority rules situation to repeal or great modify a number of items. Actually, many items.
Indeed — if we couldn’t get it done with a bicameral supermajority, the White House, and upwards of 75% of the public in favor of a public option, it’s clear its absence was a matter of choice. Republicans accomplished more with a minority in both Houses.
what a tangled web we weave will be obama’s epitaph
I’ll ask again, why would Republicans want to repeal a Republican plan? It is far more useful to them as a perennially unpopular program with which they can bludgeon their Democratic opponents.
She also falls into the fallacy of assuming that each and every provision must be deficit reducing; but a reconciliation bill can have deficit increasing provisions as long as the whole bill reduces the deficit… The GOP could, for example, have the reconciliation bill appear to implement a beefed up version of the excise tax at the end of 10 years, knowing no future Congress would allow the tax to take effect.
Excellent post Jon. Clearly the Democrats didn’t understood the importance of those two points in 2009 (and don’t understand it now).
They could have funded “revenue-neutral” healthcare reform with a tax hike of $1 trillion a year starting in 7 years. They could then start spending $300 billion a year on HCR immediately with confidence that, regardless of who controls Congress in 7 years, the new taxes will never go into effect. They could have even pulled in the start date of this rainbow tax to 6 years to “pay for” an additional $1 trillion in stimulus spending.
The whole fiasco with the ACA says to me that the Democrats are spineless, stupid, or they passed exactly what they wanted. I vote for the later. A transfer of wealth to big pharma and the private insurance company’s.
good
Good enough, assuming SCOTUS doesn’t geld ACA first via the mandate. I’d much prefer SCOTUS be the end of ACA rather than a GOP House/Senate/WH running everything in 2013 and beyond.
I’m still flummoxed about the lack of a severability clause in ACA. An oversight? Or was that intentional thinking it might make it more difficult for SCOTUS to kill any of it?
The lack of a severability clause in ACA did not prevent the courts from saying they only held invalid the mandatory personal freedom portion – the “mandate” to buy.
But the USSC is likely to note the lack of a severability clause in ACA and knock down the whole law. The only thing that might save it is the fact it is a $600 billion welfare check to the insurance companies via the subsidy paid the companies for the lower paid folks. Our USSC rarely screws our companies out of a theft of tax dollars.
So John I suspect has the likely senario correct – a simple budget bill that destroys the exchange concept. Meanwhile those insurance rules as to pre-existing conditions will be shot down by the courts (a taking that is not compensated for), since the Congress can’t kill them via a budget bill.
Meanwhile those insurance rules as to pre-existing conditions will be shot down by the courts (a taking that is not compensated for)
I doubt that would fly, doesn’t New York and a couple other states already have pre-existing condition rules? A business opportunity is not a property interest.
the current pre-existing rules prohibitions are for moving from a group policy with one employer to a group policy with another within “X” days. While the forever forget about pre-existing idea does not exist, group health “at work” on day one rules acting as the underwriting for group policies in many states may be what you were referring to, although most policies also demand a statement that effectively says you did not just get out of the hospital.
It is not like the kids on parents group policy to age 26 where no rules as to premium were set (the Univ of Illinois set the cost of a 22 year old addition to the parents policy at about an $8000 additional premium as I recall).
On an individual policy, the interim, until HCA fully ends “pre-existing” rules, “high risk” pools do not limit the premium in the high risk pool – and can continue – albeit very few persons are using those high risk policies.
But you may be correct as to treating “no pre-existing rules” as a statutory policy provision that is a cost of doing business as perhaps not being a taking.
But the long term care idea died as the actuaries said it would because of the anti-selection of no underwriting in an opt-in policy pool – a month before you need the nursing home you sign up for the benefit does not make for a self supporting premium system.
If they try the statutory provision cost of doing business approach there will be a court case and in all the state cases that I am aware of the ins companies win the right to raise premiums (with many choosing to not sell anything – as would be the case if no claim sharing or reinsurance pools), – every time. As this attacks the anti-selection principle that is the basis of any non-universal coverage business, the court is likely to see a non-universal approach as a taking of the business.
In any case, Congress can not use budget rules to remove the pre-existing rules under HCA – albeit those rules will not survive the courts, or the market place, in a “no mandate” world.
An example of a high risk pool under HCA (this is not via an insurance company)
Pre-Existing Condition Insurance Plan: Vermont
Eligible residents of Vermont can apply for coverage through the Pre-Existing Condition Insurance Plan program run by the U.S. Department of Health and Human Services.
To qualify for coverage:
You must be a citizen or national of the United States or lawfully present in the United States.
You must have been uninsured for at least the last six months before you apply.
You must have a pre-existing condition or have been denied coverage because of your health condition.
PCIP covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a preexisting condition.
Please note rates have changed as of July 1, 2011. The monthly premiums for your state are:
Age Standard Option Extended Option HSA Option
0 to 18 ……..$148 $199 $154
19 to 34……..$222 $298 $230
35 to 44……..$266 $357 $276
45 to 54……..$339 $457 $352
55+………….$472 $635 $490
In addition to your monthly premium, you will pay other costs. In 2011, you will pay a $1,000 to $3,000 deductible, which varies by your plan option, for covered medical benefits (except for preventive services) before the plan starts to pay. A plan option may have a separate drug deductible. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.
What were once considered the arcane rules that guaranteed civility have turned the Congress into a farce.
Try to explain this headline to a middle school student.
“Pres. Obama’s Jobs Bill Fails: Senate Votes 51-48 Aye.”
Excellent analysis, Jon, “…the Democrats didn’t pass a more progressive law, because they didn’t want a more progressive law.”
Which explains with impeccable clarity the answer to your post over at “Elections” … “If Only the Democrats Had Used Reconcilliation to Pass Health Care”.
They, the Democrats, didn’t want to.
What reasonable conclusion may be drawn, by any who are convinced that there is only ONE “political party”, in these United States of the “Homeland”, the $uck-up-to-corporation$-party?
That it makes very little difference which “end” of that party has “power”, and that, EVERY election cycle for decades has resulted and will continue to result in severe “cut-backs” and measurable losses for “the people”.
What actual difference does it make and HOW does it actually matter, to flesh and blood human beings, whether the “Republican” end of the $utc$ party uses “reconcilliation”?
It is still … the same old same old, is it not?
Tell us, regardless of which end of the $utc$ party gains the White House or controls Congre$$, what REAL difference this will make for “the people”, who, to be blunt about the reality of their “situation”, are royally screwed … either way?
Do you see a rational health care system anywhere on the horizon, or even beyond? This matters, of course, because such a reasonable system would have profoundly positive economic effects, as any number of thoughtful economists have been pointing out …
You speak to what people “believe” … let us ponder upon something which people “believe”, shall we?
People now “believe” that “children”, over the age of eighteen, may be placed on their parent’s insurance policy … this is true ONLY if the parent’s employers agree to do so … yet most people “believe” that some “mandate” or “rule” exists which insists that such coverage be made available.
I realize this is but a “detail” … yet that is precisely “where” the devil is … in the unexamined “horns” of the details.
DW