nuclear option for health bill forced by bipartisanshipAfter a very public display of partisanship at President Barack Obama's health care summit on Thursday, the public clearly saw that no real attempt at bipartisanship is possible on the health bill. If the Democrats want to pass health care legislation this year they most likely will need to use what's commonly called the "nuclear option," but officially called, in Senate terms, "reconciliation" to solve differences between bills passed by the Senate and House. Generally these bills cannot include provisions that are "extraneous" to taxing and spending.

The reconciliation process allows the Senate to vote on a simple majority and prevents the use of a filibuster. Democrats lost their filibuster-proof majority after Sen. Scott Brown won the Massachusetts election in January. Now the Republicans have 41 votes and can use the filibuster process to stop any vote on health care.

Republicans have used the "nuclear option" 16 times since it was first introduced during former President Reagan's term in office in 1980. Democrats have used it just six times. Former President George W. Bush's 2001 tax cut was passed using the "nuclear option."

The final arbiter over what can and cannot be included in a bill using the reconciliation process is the Senate's parliamentarian, Alan Frumin, 63, who has served under both Republican and Democratic majorities. Analysts expect Democrats to change the Senate bill by improving subsidies, easing a tax on high-cost insurance plans, enhancing prescription drug benefits to the elderly and cutting or increasing Medicare and Medicaid. They also are expected to eliminate federal aid the Senate added to pacify Sen. Ben Nelson of Nebraska for expanded Medicaid coverage for Nebraska.

Under the rules of reconciliation only 20 hours of debate are permitted, rather than unlimited debate allowed during a filibuster, which needs 60 votes to stop. Republicans now control 41 votes, so they can use the filibuster to avoid any vote in the Senate under current rules. If the Democrats do use the "nuclear option," they will probably find it difficult to pass any bill on a bipartisan basis, but I doubt bipartisanship is possible during an election year anyway.

So are Americans ready for a health bill? When one first looks at the poll released Tuesday by the Kaiser Family Foundation, one might answer no. The poll showed that the 43% of those polled were in favor of the bill and 43% were against. But when you start looking at key aspects of health reform legislation you see a very different story:
  • 76% support reforming the way health insurance works; even 64% of Republicans can agree on that.
  • 72% support tax cuts for small businesses; even 67% of Republicans can agree on that
  • 71% support a health insurance exchange/marketplace; even 67% of Republicans can agree on that
  • 71% support help in closing the Medicare "doughnut hole;" even 66% of Republicans can agree on that
  • 70% support expanded high-risk insurance pools; even 61% of Republicans can agree on that
Only one major provision did not get a majority of Republican support. While 68% of the poll respondents supported financial help for low and middle income Americans, only 48% of Republicans supported that aspect of the bill. Democrats support this provision by 88% and independents support it by 64%. Clearly, when all the political noise is erased and the public is asked about key provisions of the health care reform legislation, there is majority support for most of these provisions. You can view a 38-page comparison of the health care reform legislation including provisions of the House, Senate and Obama bills at the Kaiser Family Foundation Web site.

Clearly, it's time for a simple majority vote either up or down on heath care reform. After almost a year's worth of committee hearings on the bill in three House committees and two Senate committees, we've seen enough debate and discussion. While I assume the Republicans will delay the final vote as long as they can, their games will finally end. Even though the "nuclear option" ends debate after 20 hours, the Republicans can continue to offer as many amendments as they want and delay the vote as long as they want to physically play the game. But, since there is crucial financial legislation that needs to be taken up, let's hope the games don't go on too long. It's time for a vote on health care legislation so the Congress can move on to other crucial issues facing this country.

Lita Epstein has written more than 25 books including The Complete Idiot's Guide to Social Security and Medicare and Surviving a Layoff: A Week-by-Week Guide to Getting Your Life Back Together.



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