Monday, February 1, 2010

Guest Commentary: Is Health Reform DOA?

Joe Couto, PharmD, MBA
Outcomes Research Fellow
Jefferson School of Population Health

The recent election of Scott Brown to the Senate has cast a rather sizeable storm cloud over President Obama’s proposed health reform. There exists the possibility that those senators in opposition will filibuster, thus preventing a vote on a revised health reform bill. Yet while Senator-elect Brown has stated publicly that “the one-size-fits-all plan that is being pushed nationally -- doesn't work,” he was a supporter of the Massachusetts legislation that has resulted in the nation’s lowest uninsured rate, 2.8%. So could he actually support a health care bill? Almost assuredly not, as much of Sen. Brown’s support came from special interest groups that would make sure his stay in Washington was limited to one term if he were to vote yes on the bill currently being crafted.

The question then becomes, is there another way the final bill could pass despite the threat of a filibuster on the horizon? The answer, surprisingly, is yes. While its use is relatively rare, Senate Democrats could pass pieces of the health reform bill through a process called “reconciliation”, which is reserved for bills related to spending or taxes. The gory details of this process are unimportant; in a nutshell, only a simple majority would be required to pass this legislation, not a filibuster-proof super majority. It also avoids a filibuster, since debate is limited to a total of 20 hours. Passing legislation with such broad ramifications in this manner may prove to be unpopular with voters. Unfortunately, it may be the only option to pass health reform in a deeply divided Washington.