The budget reconciliation process is the obvious way forward for enacting health care reform.  It is also the way in which Congress has customarily proceeded in the US to enact major legislative changes.  It is also known as majority rule, a principle taken for granted in most other democracies.  The Republicans enacted the Bush 2001 tax cuts, which cost at least $1.8 trillion, and the 2003 Bush tax cuts, which cost $1 trillion, as well as the abolition of the Aid to Families with Dependent Children program in 1996 through reconciliation.  Major health policies enacted through reconciliation in the US include the Children's Health Insurance Program, the Medicare Advantage program, the COBRA continuation coverage provisions, and the emergency medical treatment and active labor act.  We have a  budget reconciliation act every year or two in the US that makes major changes in Medicare and Medicaid.  The procedure is tricky and you can't do everything through it (if you want to learn more, see my post at http://www.oneillhealthreformblog.org/) but there is nothing unusual, underhanded, or overbearing about it. 
Timothy Stoltzfus Jost
Robert L. Willett Professor
Washington and Lee University School of Law
(540) 564 2524
(540) 458 8510
(540) 421 1529
fax (540) 458 8488
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From: Anglo-American Health Policy Network [[log in to unmask]] On Behalf Of Adam Oliver [[log in to unmask]]
Sent: Tuesday, January 26, 2010 12:23 PM
To: [log in to unmask]
Subject: Today's Spotlight, forwarded by Howard B.

SPOTLIGHT: RISKY PROPOSITION
Congressional Democrats appear to have agreed on a strategy to have the
House pass the Senate health reform bill and use the budget
reconciliation process to make changes that are acceptable to House
liberals, senior Democratic aides said Monday. The maneuver will require
the House to pass the Senate legislation unchanged but would give the
House an opportunity to make some substantive modifications that would
only need 51 Senate votes for approval. However, it remains unclear
whether the House -- even with the proposed changes -- has the votes to
pass the Senate bill, because the budget reconciliation procedure is
subject to rules that could make it difficult to include some key
provisions that might be necessary for House passage. Rules governing
the budget reconciliation procedure limit any changes to provisions that
solely affect taxes and government spending, which complicates how some
criteria -- such as how to restrict taxpayer funding for abortion
services -- would be handled. In addition, using the budget
reconciliation procedure is risky particularly because it could incite
political backlash against Democrats.

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