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Democrats face health care hurdles amid talk of reconciliation

By Ed Hornick, CNN
Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi attended the bipartisan health summit last week.
Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi attended the bipartisan health summit last week.
  • Reconciliation allows budgetary measure to pass in Senate with 51 votes
  • Democratic leaders are looking at using the parliamentary procedure
  • House and Senate Democrats are divided over items between the two bills
  • Reconciliation bills have been signed by Democratic and Republican presidents

Washington (CNN) -- While Democrats have recently threatened to use a parliamentary procedure to pass the health care reform bill, it is unclear whether their caucus will even have enough votes to take the first step.

Congressional negotiators have been working toward melding both chambers' bills -- which passed last year -- so the legislation can move forward. It stalled when Democrats lost their supermajority in the Senate with the upset victory of Republican Scott Brown in the Massachusetts special election.

Democrats have been weighing the use of budgetary reconciliation. It's a parliamentary procedure that allows a measure to pass on a simple majority vote of 51, rather than the 60 needed to break a filibuster.

But Republicans have warned that use of the procedure or any other tactics to get health care reform passed will have consequences for Democrats come November. Fearing a backlash over using reconciliation, Democratic leaders and the White House have noted Republicans used reconciliation many times for their legislation.

Democrats, meanwhile, are pushing forward. On Monday, White House Press Secretary Robert Gibbs said President Obama "believes that an up or down vote is necessary" and will soon present another version of what he believes health care reform should look like.

Gibbs said the president will give a speech, likely on Wednesday, and he will discuss "the way forward." The speech will address the process of getting something passed. That could include the use of the parliamentary procedure.

Video: Health care moving forward?
Video: GOP health care prediction
Video: Pelosi backing Obama plan?

Reconciliation, established in 1974, makes it easier for the Senate to pass bills to reduce the nation's debt. The procedure has been used 22 times, and every president beginning with Jimmy Carter has signed bills that used reconciliation.

"President Reagan used the rule to pass big tax cuts; President Clinton used it to pass a set of tax reforms; and President [George] W. Bush was fond of using reconciliation as well" in passing his tax cuts, said David King, a public policy lecturer at Harvard's Kennedy School of Government.

Sen. Kent Conrad, D-North Dakota, said on CBS' "Face the Nation" Sunday that reconciliation "cannot be used to pass comprehensive health care reform." Conrad, chairman of the Senate Budget Committee, added that it "won't work because it was never designed for that kind of significant legislation."

David Drucker, who covers Congress for Roll Call, said that using reconciliation will be tricky.

"These things are ultimately subjective, and so it's do-able," he said. "I talked to Democrats who say that they wish that people who want this understand how difficult it is to pull off. But it is doable even though it's difficult."

What is reconciliation?
Reconciliation is a process, limited to budget-related bills, that bypasses the Senate rule on 60 votes being needed to end debate, known as cloture. By using reconciliation, only a majority vote would be needed to advance a bill.

It was established by the Congressional Budget Act of 1974, in part, to lower the bar for passing tough deficit-reducing legislation.

Debate on reconciliation measures in the Senate is limited to 20 hours.
According to a report by the Congressional Research Service, 22 bills have been sent to presidents through the use of reconciliation from 1981 to 2008.

Many of the 19 reconciliation measures that became law since 1981 involved substantive policy issues such as federal health care programs, tax exemptions and Social Security.

Even before reconciliation could be considered, Democrats must come together to iron out key sticking points -- including abortion and the government-sponsored public health care option.

The abortion issue has been vexing for Democrats in the House. Rep. Bart Stupak, an anti-abortion Democrat from Michigan, pushed for measures in the House bill to which pro-choice Democrats were opposed.

Drucker said Democratic factions in the House will make it tough for the bill to move forward, adding "the Senate abortion language doesn't satisfy [conservative Democrats]."

But in the end, it's about the vote count, a congressional expert said.

"My sense is there aren't enough votes in the House to pass the Senate-passed bill," said Craig Volden, a professor of political science at Ohio State University. "It's not clear what bill would pass the House that would also get 50 votes in the Senate, even if they went with reconciliation."

Volden said the House and Senate will be hesitant to vote on anything they don't think will go all the way through to final passage.

And on the issue of the public option, liberal Democrats in the House and Senate still hope it will be included in the final bill even though it's not being supported by the president.

Recently, a group of 30 Senate Democrats indicated its support for keeping a public option in the bill. Some of those Democrats include Senate Majority Whip Dick Durbin, along with Sens. Jeff Bingaman, Ben Cardin, Amy Klobuchar and Chuck Schumer.

But House Speaker Nancy Pelosi, a vocal supporter of the public option, has admitted it would not be in the final bill.

Asked about the White House's decision to not include the public option, Gibbs has said the decision was made because it did not appear that there would be sufficient votes to get the public option passed in Congress.

Another issue for Democrats in using reconciliation: The 2010 midterm elections.

With polls showing opposition to the Senate's health care reform bill, many conservative Democrats up for re-election are worried that voters will push them out in November.

King, who also serves as the faculty director of Harvard's program for Newly Elected Members of the U.S. Congress, said Democrats' "base calculation is probably political."

"The Scott Brown election [in Massachusetts] has -- in the minds of many members -- changed their re-election calculations."

Some Democrats may be especially concerned about accusations from Republicans that they short-circuited the legislative process.

Republicans are already seizing on Democrats' worries.

Sen. Lamar Alexander, R-Tennessee, said that if the bill passes through reconciliation, a new set of headaches begin for Democrats.

"Then for the rest of the year," he said on ABC, "we're going to be involved in a campaign to repeal it."

Democrats have faced a large pushback from Republicans on the issue. House Minority Leader John Boehner has even gone so far as to call for both bills to be scrapped and for Congress to start over. Should Democrats use reconciliation, Republicans will more than likely use it against them.

But the White House is calling Republicans out, noting that every Republican senator who took part in last week's health care summit has voted in the past for a reconciled bill.

Nonetheless, Republicans have said that using that parliamentary procedures for a health care reform bill can't be justified.

"Just because it has been used before for lesser issues doesn't mean it's appropriate for this issue," Senate Minority Leader Mitch McConnell has said.

Julian Zelizer, a political historian and contributor, said the Democratic leadership must be proactive in responding to reconciliation criticism.

"They will have to explain that reconciliation is a legitimate process by pointing to the history," he said in a commentary. "They will also have to connect the dots for voters frustrated with the ineffective government by explaining that the constant use of the filibuster has turned the Senate into a supermajority institution where both parties have found it extraordinarily difficult -- virtually impossible -- to pass major legislation."

CNN's Dana Bash and Suzanne Malveaux contributed to this report.