Comments from President Obama’s budget director may signal a complicated parliamentary showdown over health care in the Senate later this year. At stake is whether the White House needs 60 or only 50 votes in the Senate to pass its reform of the nation’s health insurance system.
And the Senate Parliamentarian, an unelected, non-partisan official who is already considered a crucial figure in the health care debate, could find himself with even more questions to tackle than originally expected.
A letter from the Congressional Budget Office on Saturday dashed White House hopes of easily covering the trillion-dollar cost of its health care reform package. The president’s proposed Independent Medicare Advisory Council (IMAC), which he held up during last Wednesday’s press conference as a way of saving on Medicare in the long run, will save only a pitiful $2 billion over ten years, or less than one percent of the health bill’s overall cost. Obama had described IMAC as “a panel of doctors and health-care experts advising on how we can get a better value for our money in Medicare. And every expert out there says this can be a valuable tool to start reducing inflation over the long term.”
In response to the CBO letter, Peter Orszag, President Obama’s budget director and also a former CBO director, tried to put the best face on it he could. He noted, for example, that CBO is often over-zealous in its bean-counting, and that White House officials should pat themselves on the back over having saved even $2 billion according to their account.
“The bottom line is that it is very rare for CBO to conclude that a specific legislative proposal would generate significant long-term savings so it is noteworthy that, with some modifications, CBO reached such a conclusion with regard to the IMAC concept,” wrote Orszag on his blog at WhiteHouse.gov.
But one phrase that Orszag uses to describe IMAC within the health care bill is particularly noteworthy: “[T]he IMAC is a game changer not a scoreable offset,” he wrote.
The reason this is noteworthy is that Democrats have long been discussing bypassing the requirement for a 60-vote majority in the Senate by passing their health care package as a budget reconciliation bill.
Typically, budget reconciliation bills need only a majority to pass the Senate. They can still be blocked by the so-called “Byrd Rule” when they fail to come in according to the reconciliation instructions contained in the budget — this year, that means they must improve the budget’s bottom line by just a few billion dollars overall. But that could mean they spend $996 billion more over ten years and raise taxes by a bit more — $1 trillion.
As matters stand, the House health care creates a $240 billion budget hole, even after counting its new taxes on payroll and high-income individuals. So in theory, the Byrd rule could shut it down, ending hopes that a health care bill could pass on an expedited procedure.
But one exception to the Byrd Rule is items that are considered “un-scoreable” — specifically, items that will “likely produce significant reduction in outlays or increase in revenues, but due to insufficient data such reduction or increase cannot be reliably estimated.” The word “scoreable” appears to allude to this exception — although this path may still require more Republican cooperation than appears to be forthcoming.
The ultimate arbiter of what is and is not covered by the Byrd rule is the Senate parliamentarian, Alan Frumin. Look back to this April piece in The Hill for more information about him and his office’s potential role in the health care debate this year. Frumin has worked in the parliamentarian’s office for three decades, and he is not considered a pushover.
Unless they can get around the Byrd rule, Democrats have a tough choice. Either come up with $240 billion that the government doesn’t currently have (IMAC was a first, failed attempt at this), or else find 60 votes in the Senate. Neither option will be easy.
