The Truth About Reconciliation

Health care's got a history with reconciliation

by David Waldman

Wed Feb 24, 2010 at 07:45:02 AM PST

NPR is running a good roundup aimed at debunking the popular obstructionist myth that the use of the reconciliation process for passing a health care bill would somehow be unprecedented or represent some kind of wild departure from Congressional rules and traditions. But as I've occasionally insisted on reminding people via Twitter:

If you've ever had COBRA coverage, you had it because of reconciliation. It's the "R" in COBRA.

In fact, the whole acronym stands for Consolidated Omnibus Budget Reconciliation Act, which refers to the bill that the well-known program of extended health benefits was included in when it passed Congress in 1985.

But as the NPR story notes, there's much, much more to the picture:

[V]ia a series of budget reconciliation bills, beginning in 1984, Congress began expanding Medicaid coverage. In 1997, also in a budget reconciliation bill, it created the Children's Health Insurance Program, known as CHIP. Today, says [GWU Prof. Sarah] Rosenbaum, who helped write many of the children's health provisions in those bills, Medicaid and CHIP together cover 1 in every 3 children in the United States.

"So literally we've changed everything about insurance coverage for children and families, and we've changed access to health care all across the United States all as a result of reconciliation," she says.

And...

"Going back even close to 30 years, if you start say in 1982, the reconciliation bill that year added the hospice benefit, which is very important to people at the end of life," says Tricia Neuman, vice president and director of the Medicare Policy Project for the Kaiser Family Foundation.

Over the years, budget reconciliation bills added Medicare benefits for HMOs, for preventive care like cancer screenings; added protections for patients in nursing homes; and changed the way Medicare pays doctors and other health professionals.

There's so much there, in fact, that NPR ended up posting it in sidebar chart form, too:

A History Of Reconciliation

For 30 years, major changes to health care laws have passed via the budget reconciliation process. Here are a few examples:

1982 — TEFRA: The Tax Equity and Fiscal Responsibility Act first opened Medicare to HMOs

1986 — COBRA: The Consolidated Omnibus Budget Reconciliation Act allowed people who were laid off to keep their health coverage, and stopped hospitals from dumping ER patients unable to pay for their care

1987 — OBRA '87: Added nursing home protection rules to Medicare and Medicaid, created no-fault vaccine injury compensation program

1989 — OBRA '89: Overhauled doctor payment system for Medicare, created new federal agency on research and quality of care

1990 — OBRA '90: Added cancer screenings to Medicare, required providers to notify patients about advance directives and living wills, expanded Medicaid to all kids living below poverty level, required drug companies to provide discounts to Medicaid

1993 — OBRA '93: created federal vaccine funding for all children

1996 — Welfare Reform: Separated Medicaid from welfare

1997 — BBA: The Balanced Budget Act created the state-federal childrens' health program called CHIP

2005 — DRA: The Deficit Reduction Act reduced Medicaid spending, allowed parents of disabled children to buy into Medicaid

Yes, despite the claim made by the random Republican caller to C-SPAN claimed during Darcy Burner's appearance on Washington Journal this morning that reconciliation had never been used to pass any legislation of any kind (!!!), the procedure has in fact been used dozens of times, on several occasions for exactly what opponents of health care reform insist has never, ever, ever been done.

No wonder Republicans want to eliminate public broadcasting.