Health care reform still up in the air

The Politico reports that "Senate Democratic leaders said Monday that they don’t expect to have a decision on how to move forward with health care reform in time for President Barack Obama’s State of the Union address on Wednesday." This comes as a surprise to me. The Washington Post reports today on House Majority Leader Steny Hoyer's (D Md) comments today on possible options -- no bill, a scaled back bill, and passing the Senate bill with a "sidecar" reconcilation bill that makes mutually acceptable changes to the Senate bill, such as the so called Cadillac tax compromise that was worked out before the Massachusetts election. The Senate can bypass filibusters with the reconciliation approach, but reconciliation measures must be budget related.

How is this restriction enforced? The Center on Budget and Policy Priorities explains that

While reconciliation enables Congress to bundle together several different provisions affecting a broad range of programs, it faces one major constraint: the “Byrd rule,” named after Senator Byrd of West Virginia. This Senate rule makes any provision of (or amendment to) the reconciliation bill that is deemed “extraneous” to the purpose of amending entitlement or tax law vulnerable to a point of order. If a point of order is raised under the Byrd rule, the offending provision is automatically stripped from the bill unless at least 60 senators vote to waive the rule. This makes it difficult, for example, to include any policy changes in the reconciliation bill unless they have direct fiscal implications. Under this rule, authorizations of discretionary appropriations are not allowed, nor are changes to civil rights or employment law, for example. Changes to Social Security also are not permitted under the Byrd rule.

In addition, the Byrd rule bars any entitlement increases or tax cuts that cost money beyond the five (or more) years covered by the reconciliation directive, unless these “out-year” costs are fully offset by other provisions in the bill.

Business Insurance reports today that Democratic Senators Blanche Lincoln (D Ark) and Evan Bayh (D Ind.) have announced their opposition to the use of the reconciliation sidecar. "But the No. 2 Democrat in the Senate, Dick Durbin, D-Ill., said reconciliation remained a viable option on health care." Last week, the House Speaker ruled out a fourth option -- simple House passage of the Senate bill -- because she does not have the votes.

So we continue to wait. But one thing is certain. The moratorium on a 21% cut in Medicare and Tricare reimbursements to doctors ends in a little over four weeks. Medical News Today reports that "National groups [the American Medical Association, AARP, and the Military Officers Association of America] are calling for a permanent solution to the doctor payment formula and warning about a possible shortage in doctors and impending decline in Medicare payments." But how can Congress provide a permanent solution when the President is about to propose a three year freeze on non-discretionary spending in next week's FY 2011 federal budget proposal, according a New York Times report. Of course, it can do so because it is Congress. Alternatively, Congress can always kick the SRG can down the road a little bit farther, making the day of reckoning more imposing.