Video: Changing 'the fixes' in the health bill

  1. Closed captioning of: Changing 'the fixes' in the health bill

    >> the pain is down the road. now let's move on to the senate where all this action is going to be on this, quote, reconciliation. the pressure is on majority leader harry reid to pass the bill's fixes without any major revisions that would kick it back to the house . we'll bring in our chief senate producer here ken strickland. we saw that the house had to pass the senate bill word for word in order to avoid some sort of tossing the vote back in a tough vote in the senate again. now the senate must do the same thing. are they going to be able to do it?

    >> if history is any guide, this is going to go back to the house one more time. since reconciliation was invented there have been 22 reconciliation bills. 21 have had to go back to the house for changes. this is what the trust issue is about. this bill of fixes was what house democrats had to have to pass the senate bill . things in there that protected constituents like labor groups . and right now republicans are basically lying in wait, scrubbing this bill a word at a time looking for anything -- first of all, they want to kill the bill. there are 19 different procedural ways they can do it. that may not happen. but if they can score a political point and take out something that is very important to them -- for example, the cadillac tax -- they're gunning for that saying in some weird way, indirect way, it has an impact on social security and under the rules of reconciliation there can be no impact on social security . it's going to be interesting.

    >> because the notion is if the change -- if the reconciliation bill that was passed last night changes in any way it goes back to the house . but it seems the real danger for democrats is if republicans are able to get that reconciliation bill changed in a way that matters in terms of the house consentsus. what is the most fertile ground?

    >> we talked about the cadillac tax. imagine this scenario. one of the biggest sticking points -- when we debated in january he said we have a deal with the labor unions on the cadillac tax because democrats feel it would adversely effect labor unions and the middle class . they made a deal to soften the blow and delay it. republicans are gunning for that and can strip it out. not only would it have to go back to the house but the labor unions would be incensed.

    >> and in the house they have a lot more pressure points frankly than the senate so they can have success maybe killing it in the house .

    >> thanks. our parliamentarian. we've seen a lot of you this

By Senior producer
NBC News
updated 3/22/2010 1:42:25 PM ET 2010-03-22T17:42:25

So, now what?

Relieved Democrats may still be celebrating the passage of landmark health care overhaul legislation , but Republicans in the Senate still have an opportunity to try to derail the bill.

And if history is any guide, they are likely to force the House to vote on health care again before Easter. "Anybody that thinks that this is only going to be a one-time deal today in the House, I think, is grossly mistaken," said Republican Sen. Orrin Hatch on CNN's "State of the Union."

Late Sunday, the House passed the Senate's version of the comprehensive bill, and because most members didn't like it, they also passed a smaller bill of so-called "fixes."

Passing of those subsequent fixes was a critical component to passage of the Senate bill for House Democrats.

Without them, House Democrats would have been supporting a bill with elements deemed largely undesirable. A promise by Senate Majority Leader Harry Reid that the Senate would work to approve the package of fixes coaxed "yes" votes from many Democratic lawmakers who had previously indicated they might oppose the Senate bill.

On Tuesday, the Senate is expected to formally start its work on the fixes bill using a little-understood procedure known as reconciliation.

For Democrats, reconciliation is the perfect antidote to what they feel is Republican obstructionism in the upper chamber. The process is filibuster-proof, requiring only 51 votes for final passage rather than the usual 60 to overcome a blockade by the minority party.

For Republicans, reconciliation is their best chance to kill the smaller bill or make changes to it. Because the House and Senate must pass the same bills — word for word — even a minor tweak would send it back to the House for another vote.

Republicans hope to force major changes to the reconciliation bill, some that could set up a political nightmare scenario for Democrats. If certain unpopular provisions of the Senate’s version of the bill — like special carve-out deals for individual states — are not corrected, Democrats risk being branded as supporters of back-room deals. And if Republicans manage to scuttle reconciliation language that would delay the implementation of new taxes on high-value insurance plans, union groups who were counting on the fix will be incensed.

In the 22 times that reconciliation has been used, only once has the Senate bill not been changed and sent back to the House.

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Reconciliation's basic rules
Reconciliation is a fast-track legislative process specifically designed to reduce deficits. Debate is limited to 20 hours, but an unlimited amount of amendments can be offered and voted upon.

Every line in a reconciliation bill must adhere to strict rules to ensure a budgetary impact or else risk being eliminated by the non-partisan Senate parliamentarian. Here lies the biggest opportunity for the GOP.

Cutting up the bill
To ensure that all provisions of the bill have a budgetary impact, the rules of reconciliation allow Republicans to raise 19 different types of objections.

Video: House OKs bill

The most commonly used objection (also called a "point of order") is known as the “Byrd Rule,” named after its author, West Virginia Sen. Robert Byrd.

This can be raised against any part of the reconciliation bill that does not address budgetary matters. The extraneous matter would be removed from the bill if the parliamentarian, Alan Frumin, upholds that point of order.

"House Speaker Nancy Pelosi's reconciliation fixes could easily be blown to pieces in the Senate," Sen. John McCain, R-Ariz., said on the Senate floor last week.

Reid can ask for a vote to overrule the parliamentarian, but it would take 60 "yes" votes in most cases. With the election of Massachusetts Republican Scott Brown in January, Democrats only have 59 votes in their caucus.

There are also other rarely used points of order which could be used to effectively kill the entire bill.

Amendments to the bill
Adding new elements to the bill would also send it back to the House for another vote.

Under reconciliation, an unlimited number of amendments can be offered by Democrats or Republicans. Republicans haven't tipped their hand on strategy, but have made it clear they will offer dozens.

Republicans say the rules will allow them to offer a broad array of amendments. The topics could include anything within the jurisdiction on the two Senate committees that produced the health care bill: finance and health (which also includes education, labor, and pension issues).

New Hampshire Republican Judd Gregg has encouraged his GOP colleagues to submit amendments that are "serious and relevant," according to an aide. "I can't say there will be no crazy immigration stuff because we never can tell what certain people will do," the aide said.

Video: Change for Obama, Dems?

Such a wide open field could require Democrats to make some tough votes on hot button issues like taxes, Medicare cuts, Medicaid, immigration, and labor. This could prove especially problematic for those Democrats facing re-election.

Democrats say they'll ask the parliamentarian to rule that Republicans are being "dilatory" or delaying the process by offering too many amendments. Multiple Republican sources have suggested they're more interested in quality than quantity.

"You can be serious and relevant for a long time," the GOP aide said. "I think there's plenty of issues that can be covered without treading into that dilatory area."

Votes of the amendments would likely come at the end of the debate in what is called the "vote-o-rama."

The parliamentarian
It's clear the process puts a lot of power in the hands of the parliamentarian.

He alone rules whether something should be eliminated from the bill or if Republicans are employing stalling tactics. (The Democratic senator presiding over the Senate at the time, which could be Vice President Joe Biden, can choose to ignore Frumin's advice, but aides say Senate leaders will respect the parliamentarian's rulings.)

Many of the tough decisions have already been vetted in advance. On Monday afternoon, members of both parties were meeting behind closed doors with the parliamentarian to discuss the process.

"Nobody wants to surprise anybody if we can avoid it," Gregg said. "The parliamentarian deserves to have a reasonable amount of information so that he can make a thoughtful decision and is not having to take action in a situation where he hasn't had time to analyze the issue."

While the parliamentarian doesn't issue final verdicts, both sides are likely to get an early sense of which way the procedural winds are blowing.

This may reduce the risk of some "gotcha" moments on the floor, but not eliminate them completely. Republicans say they'll comb through the bill until the last moment looking for holes.

"As we come across provisions in the bill — be it before we get on the floor or on the floor — at anytime we can go down to the parliamentarian to make our case," said a Republican aide well versed in reconciliation strategy.

Democrats sheepishly admit that changes to the bill are possible. But they believe those changes would be minor and not have a significant impact on the substance or cost of the bill.

NBC's Kelly O'Donnell contributed to this report.

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