Healthcare reform: Obama nudges Congress toward reconciliation

President Obama called on Congress Wednesday to finish healthcare reform with an “up-or-down vote” in the next few weeks.

In a statement delivered to an audience including doctors and nurses in the East Room of the White House, the president made what seemed like a closing argument in a courtroom: The nation has spent the last year debating how to fix a broken healthcare system, and it’s time to move. Throughout the speech, the insurance industry came in for particular scorn.

“Everything there is to say about healthcare has been said and just about everyone has said it,” Obama said. “So now is the time to make a decision about how to finally reform healthcare so that it works, not just for the insurance companies, but for America’s families and businesses.”

Hitting the road to lobby for healthcare

Obama will hit the road next week to push the case for reform. On Monday, he heads to the Philadelphia area and on Wednesday, the St. Louis area. The goal is to finish the legislation by March 29, when Congress begins Easter recess.

In his speech, the president did not use the R-word – “reconciliation” – in describing how Congress should proceed. But he used the code phrase for reconciliation – “up-or-down vote” – in pushing for final action.

Reconciliation is a procedure that allows legislation to pass the Senate by a simple majority, not the 60-vote supermajority required to defeat a filibuster. Republicans have sought to tar reconciliation as an extreme “nuclear option,” but in fact, reconciliation has been used 22 times by both parties since 1980 – including, as Obama noted, to pass President George W. Bush’s two tax cuts and President Clinton’s welfare reform.

In this case, the House would pass the version of reform already approved by the Senate on Dec. 24, then both houses would pass follow-up legislation aimed at fixing the bill to reflect changes Democrats have agreed upon. (Monitor congressional correspondent Gail Russell Chaddock reports that reconciliation is "pure procedural warfare." Click here.)

Tough fight in an election year

As Democrats head into a tough election season, passage is by no means guaranteed in either house. No Republicans are expected to vote yes in either house.

In his remarks, Obama did not go into specifics on the content of his plan, though he did mention supporting Republican-backed elements – perhaps more to reassure wavering Democrats than to win over any Republicans. Instead, he recapped the last year of debate and in effect, exhorted Democrats in Congress to put potential political consequences aside and finish the legislation.

“We can’t just give up because the politics are hard,” Obama said. “I know there’s a fascination, bordering on obsession, in this media town about what passing health insurance reform would mean for the next election and the one after that.”

He would leave it to others “to sift through the politics, because that’s not what this is about,” he said. “That’s not why we’re here.”

'Take one for the team'

Obama is, in effect, asking endangered moderate and conservative Democrats in both houses to fall on their swords and take one for the team in voting for a reform that polls show to be unpopular. ("Democrats seem ready to trade House seats for healthcare reform" Monitor report here.)

But the reality is, whether or not health reform passes, the Democrats face very tough prospects this November – potentially even losing their majority, at least in the House. So, the Democratic thinking goes, members might as well go along and pass reform. The party leadership will allow as many of its caucus as it can to vote no and still gain passage.

Failing to pass anything may be marginally worse than passing an unpopular bill, analysts say. This is particularly true for Obama. Healthcare reform has been the top domestic priority of his first year in office, and if he winds up empty-handed, he faces diminished prestige, perhaps for the rest of his presidency.