Video: Health care viewer's guide

NBC News and
updated 3/19/2010 11:40:04 AM ET 2010-03-19T15:40:04

Democratic lawmakers hope that they are about to begin the finale of their intricate, year-long dance towards passing a comprehensive overhaul of the nation’s health insurance system.

If the music and lyrics seem a little baffling to you, you’re not alone. Deeming? Whipping? Reconciling? Even staff members on Capitol Hill are trying to keep the steps straight: Whip, vote, vote, sign, debate, vote, sign.

If you want to dance along, here are the steps that must happen for the whole process to be completed: whip, vote, vote, sign, debate, vote, sign.

STEP 1. Whip.
House Democrats need to somehow approve the Senate bill that passed on Christmas Eve of 2009. House Speaker Nancy Pelosi needs 216 “ayes” to get it done, and she and her colleagues are furiously “whipping” — or counting — how their members are planning to vote. President Barack Obama is also working the phones to lobby lawmakers who may be on the fence about their decision.

On Thursday, the Congressional Budget Office posted its final "score" or cost estimate for the “corrections” or “fixer” bill. This legislation is intended to repair what House Democrats see as the flaws in the bill which the Senate passed on Christmas Eve.

Pelosi has pledged to give the public 72 hours to read the final bill before it comes up for a vote. That countdown is expected to begin sometime Thursday afternoon.

STEP 2. Vote.
Because House Democrats aren’t really keen on directly voting for the Senate-passed legislation, which includes the much-criticized “Cornhusker kickback” and other unpopular measures, they are likely to vote instead on a “rule” outlining how the House is going to handle the reconciliation process. That rule will include language that says the House “deems” the Senate bill passed.

House Majority Leader Steny Hoyer, D-Md., said that Democrats are on track for a Sunday vote.

Timeline: Health care highs and lows

Timeout for an analogy: This “deeming” process, also known as the “self-executing rule” or the “Slaughter rule” — named after the chair of the committee writing it —  is a little bit like a tactic sometimes used by ticket scalpers in states that have rigid anti-scalping laws.

Instead of selling the tickets by themselves, these guys tuck the scalped goods into baseball hats and sell them as a package. Ostensibly, if the cops come around, they’re selling hats, even if the price tag is hundreds of dollars.

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In the case of the U.S. House, Democrats are voting for the “hat” (the rule) that also happens to have the “tickets” (health care reform) under the brim. The whole process has many critics crying foul, and some even say that it would not withstand a constitutional challenge.

STEP 3: Vote
The House also needs to pass a package of reconciliation “fixes.” This legislation will contain changes that the House wants the Senate to make to the bill. The “deeming” item mentioned in Step 2 could also be attached to this measure.

This is also expected to happen on Sunday, provided that House Democrats have enough votes to pass it.

STEP 4: Sign
The president must sign the House-passed Senate bill from Step 2. If you’re a Democrat who supports the overhaul, take a bow: Technically, at this step, health care has passed, and insurance industry reforms — like a ban on denying coverage because of pre-existing conditions — are officially enacted into law. But the bill with the president’s signature at the bottom also would contain some very unpopular measures, including the "Cornhusker Kickback" and other special deals for individual states. Democrats still have to fix those unpopular parts of the bill or else face certain disaster in the November midterms.

Obama scrapped a plan to leave Sunday for Indonesia and Australia, instead postponing the trip until June. "The president is determined to see this battle through," spokesman Robert Gibbs said Thursday.

STEP 5: Debate
Swing your partner from the south to the north side of the Capitol Dome. The ‘fixers’ bill that the House passed in Step 3 now goes to the Senate, where debate on reconciliation can begin.

These steps are particularly tricky. Here’s the rules of reconciliation:

  • There are 20 hours of debate on the legislation, 10 for each side. Democrats may waive their 10 hours to speed up the process.
  • Either side can offer as many amendments as they want, as long as they are ruled   relevant to the bill.
  • If Republicans attempt to introduce an overabundance of amendments as a stalling tactic, however, Democrats can declare that the GOP is being “dilatory.” If the impartial Senate parliamentarian agrees, Republicans will have to cut it out. The GOP will also try to raise objections to the reconciliation bill by saying that parts of the bill can’t be passed with only 51 votes. These calls are all up to the parliamentarian to decide.
  • Under the Senate’s “Byrd Rule,” named after its author Sen. Robert Byrd, D- W.V., any senator can raise an objection (called “a point of order”) to any part of the bill that does not address budgetary matters. The extraneous matter would be removed from the bill if the parliamentarian upholds that point of order. And 60 votes would be needed to overturn that decision. That could be a heavy lift.

        (Click here to learn more about the reconciliation procedure.)

Who's who in the health care debateFor the whole fixing process to be completed as fast as possible after this point, no changes can be made to this piece of legislation when it’s being debated in the Senate. If there are any changes while the Senate is debating reconciliation, the bill will have to go back to the House and approved again.

Remember, only 51 votes will be required to pass the reconciliation bill, which makes fixes to the existing health care bill. The health care bill itself has already been passed (Step 4).

Harry Reid has said that, if the House passes its version this coming weekend, the Senate will likely start tackling their portion of the work on Tuesday of next week. The goal would be final Senate passage of the fixes by the end of next weekend.

STEP 6: Sign
The president must sign the package of fixes passed by the Senate.

If all of these steps happen, a final version of the bill — palatable to most Democrats and stripped on unpopular deals with individual states — will be signed into law.

But, of course, it is still unclear if the dance will go as planned. Republicans have several opportunities to trip Democrats up as they pace out each step.

Whip, vote, vote, sign, debate, vote, sign.

And of course, it’s possible that Democrats might end up without a bill ... and with two left feet.

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