Congressional Democrats, working closely with the Obama White House, are poised to implement a parliamentary strategy for passage of a massive health care reform bill. Under the expected process, the House of Representatives will have to approve the Senate bill (H.R. 3590) even though many House Democrats object to a number of its provisions. By passing the Senate bill without changes, the bill can go to the President for his signature. At the same time, the House and Senate will consider and likely pass a budget reconciliation bill (H.R. 4872) that consists of modifications to H.R. 3590, including changes negotiated with the Administration. Once the President signs H.R. 3590, the law could be modified by the budget reconciliation bill and the end result would be the version that is agreeable to Congressional Democrats and the White House.


The first step in this process will be consideration of a House Resolution by the House Rules Committee, the panel that acts as a gatekeeper for floor consideration of legislation in that body and has the responsibility for recommending “rules” for legislative debate. As has been reported, Speaker Nancy Pelosi has orchestrated a parliamentary procedure for health care reform in which the House Resolution will contain language making it a “self-executing” rule that will allow the House to “deem” the Senate health care bill (H.R. 3590) passed by the House. If the House is able to get the necessary 216 votes to pass the Resolution (rule), the self-executing feature gives House Members the ability to say they did not actually vote on the Senate legislation and its objectionable features.

If the “deeming” Resolution (rule) receives the necessary 216 votes in the House, the next step would be House consideration of a budget reconciliation bill (H.R. 4872) containing various changes to H.R. 3590 being advocated by House Democrats and President Barack Obama. House and Senate Democratic leadership are relying on the reconciliation process because Congressional rules prohibit a filibuster of a reconciliation bill, which is typically legislation that modifies specific federal budget levels and which carries specific protections such as limited debate and majority vote (not a 60-vote supermajority). It is worth noting that budget reconciliation bills must only contain budget-specific legislative provisions and that the Senate Parliamentarian is a key player in deciding whether a provision is sufficiently budget-oriented. In the event that Republicans challenge parts of the reconciliation bill, it is possible to preserve those provisions if there are 60 votes in favor, otherwise they are stripped for lack of compliance with the strict rules governing this process. Since the reconciliation bill is not yet released, it is unclear which, if any, provisions will be challenged for failing to impact the budget.

The recent special election of Republican Senator Scott Brown to fill Ted Kennedy’s seat in Massachusetts eliminated the ability of Senate Democrats to prevent a Republican filibuster of the health care bill. Since Senate Democrats can’t count on any Republicans to vote for the health care reform bill, without the protections of the reconciliation process, their initiative would be subject to the filibuster and they would lack the votes to cut off debate.

Senator Richard Durbin, D-Ill., has indicated that if the House passes the budget reconciliation bill over the weekend, the Senate could take it up next week. It would be open to amendment in the Senate, and it is worth noting that any change in the legislation approved by the Senate would necessitate the House taking up the reconciliation bill again. It is not clear that Senate leadership has the votes to pass the changes to the health care reform legislation that will be contained in the budget reconciliation bill.

The Congressional Budget Office released its cost estimates for the health care reform bill, which indicate the bill’s price tag is $940 billion over 10 years but that some of that cost will be mitigated by reductions in other programs. The Democratic leadership released the text of H.R. 4872 and a section by section summary early this afternoon and the Speaker has committed that Members will have 72 hours to review legislative language before votes on the rule and reconciliation bill, which are expected to occur on Sunday evening March 21 at the earliest.

Links to the text of Senate-passed health care reform bill (H.R. 3590) and the budget reconciliation bill (H.R. 4872) and summary are provided herein:

H.R. 4872 - Reconciliation Act of 2010

Section-by-Section Summary

Text of the Senate Amendments to H.R. 3590 (Senate health care bill)