Reconciliation: A health reform end-run with its own obstacles

Budget reconciliation, a procedural tool that allows the Senate to avoid filibusters with only 51 votes, has become increasingly attractive to Democrats who feel they can not rely on support from more conservative Democratic colleagues or Republicans, MSNBC explains. The potential use of the procedure is a political lightning rod, but in practice, it presents its own challenges, too. Originally designed to allow senators to make unpopular cuts to social programs or hike taxes in the face of soaring deficits, Democratic leaders have argued that health reform is about controlling spending.

However, opponents can use those requirements to water down provisions that range beyond fiscal policy. For example, "a provision requiring insurance companies to issue coverage regardless of health status could be killed because there's no obvious direct connection to spending or saving federal dollars. ... When a senator wants to challenge a section of the bill, he or she objects by raising a 'budget point of order.' There are more than a dozen that could apply to a health-care bill." This explainer includes discussion of the "Byrd Rule," named for Sen. Robert Byrd, D-W.Va. (Strickland, 9/29).

Related KHN story: Democrats' Go-It-Alone Strategy (Pianin, 8/21)