Procedures for considering Health Care Legislation

By Dave Hoppe
SEPTEMBER 3, 2009

President Obama’s primary domestic policy goal is health care reform. Democrats believe it is critical that he achieve some type of reform during the next two years. The actions taken by the House and the Senate this fall will determine the nature of any final plan and the possible success or failure of the President’s goal.

In the wake of public concern about health care reform – concerns that intensified during the August recess – President Obama announced this week that he plans to address a joint session of Congress on health care next Wednesday night. Although aides reportedly say he will be more specific than he has been to date, he is not expected to release a detailed plan for legislative approval.  That said, the he is expected to signal compromise on several contentious points. The August recess town hall meetings were a surprise. What effects they will have on further action on health care in this Congress remain to be seen. But certainly the town hall meetings will have an effect on the final votes of some members and senators.

All three of the committees of jurisdiction in the House of Representatives have voted on H.R. 3200, America’s Affordable Health Choices Act of 2009.  When the House returns Energy and Commerce has committed to a markup to deal with additional amendments. Then the Leadership and the Rules Committee will meet to join the three committee-reported bills together. They will also set the standard for the debate and votes that will be taken on HR 3200 when it is presented in the House for amendments and a vote on final passage. The Speaker plans to have the bill on the floor of the House by the end of September. This is always subject to change.

Throughout the August recess there has been much debate among voters and their elected representatives about the health care legislation reported by the three House committees. There will be much internal discussion within the Democratic Caucus about the legislation and the concerns registered by constituents over the past month.

Here’s the procedure: the Rules Committee will work with the Chairmen of the Energy and Commerce, Ways and Means and the Education and Labor Committees to combine the three committee reports into one bill. In all likelihood, there will be a strict rule limiting the number of amendments that can be offered and by whom they can be offered.

In the House, this may require the Rules Committee to make in order amendment(s) that allow votes on specific changes in the committee reported plans. These amendments would be calculated to gather sufficient votes to pass HR 3200. It is unlikely at this point that House Republicans will be included in any of these discussions. They have been uniform in their opposition to the tri-committee bill and few of their proposed reforms have been successfully added in votes in committee mark-ups before the August recess. 

The Senate has taken a somewhat different tack. Senator Max Baucus and a small group of Democratic Senators have worked closely with Senator Chuck Grassley as well as Senator Snowe and Senator Enzi. While they have not reached a bipartisan agreement, they all pledged to return from the August recess and continue their discussions. The discussions will continue in an atmosphere in which the House is trying to move a bill for a vote on final passage. This is a much more difficult milieu in which to find some bipartisan agreement. Comments over the recess have also made a bipartisan agreement less likely. The President’s address to a Joint Session of Congress next week could have a significant effect on bipartisan negotiations.

If there is an agreement among members of the group negotiating in the Senate, there are several more steps that must be taken to move that agreement forward to the floor of the Senate. On the Republican side, Senator Grassley has continued to state that he needs a group of Republicans to support any bipartisan proposal before he will finally sign off on it. This could be a tall order. Senator Grassley has also indicated that if he joins in a bipartisan effort, that the agreement must not be watered down in any further steps in the legislative process.

On the Democratic side, Senator Baucus must sell any bipartisan proposal to his Finance Committee Democrats. Then he must work with Senator Reid and Senator Dodd to stitch together the Finance and HELP Committee proposals. Then he needs to get the overwhelming support of the Senate Democrats. All of this needs to be accomplished while keeping Senator Grassley and his group of Republicans on board.  Majority Leader Reid also has the option of bypassing a Finance Committee markup and taking a bill straight to floor consideration.

Assuming all of this is accomplished, the Senate product must be put together with the House passed bill. This conference report then has to gain the support of the White House. At this point the Senate still has to have 60 votes for the package to send it to the President for his signature.

If the 60 votes are not there, then a decision will have to be made as to whether the reconciliation process will be tried to get health care reform passed with a simple majority. That will lead to a very different product because of the rules under which reconciliation is considered in the Senate. The discussion of splitting the proposal into two pieces (one to be considered under reconciliation procedures and one to be considered under regular order) is an attempt to achieve both budgetary and extensive legislative changes without losing those legislative changes to the restrictions the “Byrd” rule puts on reconciliation.

If it is decided to move health care under reconciliation procedures, it may be more difficult to find 218 House members to vote for the reconciliation package than to find 51 votes in the Senate.

The President will have to make difficult final decisions on how much health care reform he can achieve and what constitutes victory. This contest will be worth watching and very important; perhaps more important than any other legislation that the two parties are debating in this Congress, with great implications for the future.

About the Author

David Hoppe is one of QGA’s most seasoned Capitol Hill veterans and the President of the firm. Mr. Hoppe brings nearly 30 years of experience working for senior Republican members, including six years as Chief of Staff to then-Senate Majority Leader Trent Lott. Mr. Hoppe maintains extensive contacts in the House, Senate and federal agencies.

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