I'm Just Five Bills

The legislative process can be tricky. Particularly with hugely important (and just all around huge) pieces of legislation. I want to look a little closer at what's going on with the issue du jour, health care reform. I'm not convinced the media has been particularly clear on explaining what's happening or why so many ideas--some of which are mutually contradictory--are floating around. Is health care reform going to be paid for with a small surcharge on high income individuals or is it paid for through an excise tax on the most expensive health insurance plans? Does it require employers to provide health insurance to employees or not? Is there a public option or not? All of these possibilities exist right now because multiple health care reform bills exist now.

Congress has been burning the candle at both ends on this one and I don't just mean they've been working hard: they lit wicks in both chambers of Congress and are letting the flames in the north and south wings of the Capitol building slowly burn toward a common point. Take a look on my crudely drawn (and slightly mal-proportioned) representation of the health reform policymaking process:



The House introduced its reform bill, H.R. 3200, in July. The text of that original proposal then went to the three different House committees that have jurisdiction over the issues covered by the bill. In each committee, H.R. 3200 went through a markup; this is the process in which members of the committee get to offer amendments to change things they don't like or correct weaknesses in the bill. Amendments garnering majority support in the committee get tacked onto the bill and once all is said and done the committee votes to report the bill out of committee and to the House floor. All three House committees finished their markups in July and we were left with three independent permutations of H.R. 3200. For the most part, the changes made in each committee weren't particularly large. The exception, I think, is the Blue Dog amendment in the Energy and Commerce Committee we talked about before that would change the way the public option works and reduce the amount of subsidies available to people.

Regardless, three slightly modified versions of H.R. 3200 came out of committee and the task now falls to the Democratic House leadership to merge them into one final House bill (i.e. figure out which changes to retain and which to ignore). So when you see a headline declaring that Speaker Pelosi is leaning towards including a robust public option in the final House bill that means she might just ignore that Blue Dog amendment. But soon there won't be three slightly different versions of H.R. 3200, there will be only one--the final House bill. This will then face a floor debate and its own amendment process but once it gets 218 votes the House will have passed a health care reform bill.

The Senate handled things a bit differently than the House. Instead of one bill heading to face trials by fire in the two relevant Senate committees (the Health, Education, Labor, and Pensions Committee and the Finance Committee), the HELP Committee and the Finance Committee each drafted their own bill. The HELP Committee finished its markup and passed its bill out of committee months ago and the Finance Committee made headlines last week when it (finally) passed its bill out of committee, picking up one Republican vote in the process. Just as the House is now merging its three versions of H.R. 3200, the Senate is working to merge the HELP and Finance bills right now. This is a much bigger task because the differences between these two Senate bills are much larger than those between the three House bills, which don't have much breathing room between them. Reportedly this merger is happening through negotiations between three principal Senators: Chris Dodd, who shepherded the HELP bill through committee when the chairman, Ted Kennedy, fell ill; Max Baucus, the chairman of the Finance Committee; and Harry Reid, the Senate Majority Leader.

Ultimately these bills will fuse into some Frankensteinian piece of legislation and the Senate will have a final bill to debate and then vote on. Assuming Democrats can secure 60 votes to defeat any Republican filibusters and can find 50 votes for final passage, the Senate will have passed its own bill.

Once all this happens, the House and Senate bills go to a conference committee of handpicked negotiators from each chamber. Out of this committee comes a final health care bill that goes back to each chamber to be voted on. If it's agreeable to both chambers, it goes to the Big Man's desk for a signature. And health care reform will be a reality.

So where are things now? The committee process is over and the merger of bills marked up in committee is happening in both chambers. Within a few weeks (maybe much sooner), both the House and Senate will be considering final bills and, hopefully, each will pass a bill. But at the moment it's impossible to say exactly what health care reform consists of because we haven't reached the point where one final (conference) bill exists. But that day isn't far off. Of course, the general form of all of these bills is the same, it's merely the details (some of which are pretty big) that differ.

Here, have some nostalgia: