Health reform is reaching an end game. Obama came out strong in his speech today for the first time drawing sharp distinctions between the two parties views on health care reform, and calling for an “up or down vote” on the bill.
Obama’s proposals last week addressed the main remaining issues between the House and the Senate: improving subsidies for low-income families, increasing the federal match for the Medicaid expansion, closing the Medicare donut hole, and raising the threshold and extending the grace period on the excise tax on high cost health plans.
The game plan is for the House to pass the Senate bill by March 19 and send it to the President’s desk. In the subsequent days they would pass a reconciliation package and send it to the Senate. The Senate would pass the bill prior to the Spring recess.
The Republicans are crying foul over the use of reconciliation. They don’t have much of a case. Many of them have voted for much larger reconciliation bills in the past under President Bush. As Jonathan Cohn helpfully reminds us, reconciliation is not being used to pass the main bill, it already passed with 60 votes in the Senate. It is being used to make a small number of changes, mainly in the financing of the bill, as the process was designed to do.
The votes are clearly there in the Senate to pass a reconciliation bill. The biggest question is the House. Nancy Pelosi has proven adept at getting the big votes through. Nothing is certain, but the odds are much higher for passage than they were two weeks ago.
It is also clear that if this bill fails it will be a long time before Congress makes another attempt at comprehensive reform.