On Health Care Who Goes First: House or Senate?

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There has been much musing around town (and on Swampland) about the tricky logistics of pushing a comprehensive health care reform bill through Congress at this point. The process will require at least three big votes: The House has to pass the Senate bill. The Senate has to pass amendments to its own plan through reconciliation. And the House has to pass the same amendments. But no one wants to go first. As Chris Matthews had it last night, “Much as in a kidnapping, the money and the baby have to be turned over as much as possible at the precise same time.”

Mike Allen channels the ether this morning and says that the House might begin working on its reconciliation vote before passing the Senate bill, a trick that involves the under-used verb “deem.” Here is one way this process might work:

The Senate does not want to go first because Republicans will be able to bottle up the reconciliation process, delaying the vote and making for another ugly sausage making spectacle that Americans hate to watch. If reconciliation takes too long, the thinking goes, then the House will never act, and the whole health care deal will die. But if the House goes first by passing the Senate bill, and the president signs it, then the incentive for Republicans to bottle up reconciliation would be diminished. Health care reform would, at that point, already be law. The horse would be out of the barn. Republicans would then be obstructing fixes to the law that would make the bill, arguably, better by getting rid of stuff like the “cornhusker kickback,” a much tougher proposition.

Here is where it gets tricky: The House is not going to vote on the Senate bill (even with a separate package of amendments to match the Senate’s reconciliation) until it is dead certain that the Senate will act. So how could those assurances be arranged? With the help of C-Span cameras, of course, or perhaps a letter from 51 Democrats vowing to pass reconciliation come hell or high water. Once the letter is read on the nightly news, the House can act, and suddenly the pressure would be on the Senate Republicans. With health care already law, the GOP will have to decide whether or not to spend weeks gumming up the Senate to delay some amendments to that bill.

Without a doubt, the whole thing is a long shot. It’s not clear that Pelosi has the votes she needs, but if she can get to 217, then it is unlikely to be all that difficult to get the Senate to 51, despite Republican carping over process. There is a path. It’s tiny. But it’s there.