Reconciliation: Not New. Not Controversial. And Wouldn't Be Used For Vast Majority of Health Reform

In Depth

How The Budget Reconciliation Process Works

Jan. 21, 2010

Not surprisingly, that has Republicans crying foul. Budget reconciliation, Sen. John Kyl (R-AZ) told reporters Tuesday, "was never designed for a large, comprehensive piece of legislation such as health care, as you all know. It's a budget exercise, and that's why some refer to it as the 'nuclear option.'"

"The use of expedited reconciliation process to push through more dramatic changes to a health care bill of such size, scope and magnitude is unprecedented," Sen. Orrin Hatch (R-UT) wrote in a letter to President Obama on Monday, urging him to renounce the possibility of trying to pass a bill using the procedure.

But health care and reconciliation actually have a lengthy history. "In fact, the way in which virtually all of health reform, with very, very limited exceptions, has happened over the past 30 years has been the reconciliation process," says Sara Rosenbaum, who chairs the Department of Health Policy at George Washington University.

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 children's health program called CHIP

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