A Viewer’s Guide to the Health Care Reform Bill Process

All eyes this weekend will be on the House, as it takes up health care reform for what is possibly (and hopefully) the last time. The goal is to pass two legislative measures: The Senate’s health care bill, which is the underlying bill that does most of the work of health care reform; and a series of amendments to the Senate bill, which are going through the budget reconciliation process and will still require Senate approval to become law.

As you can see, the legislative process stopped resembling Schoolhouse Rock a long time ago. For those who want to follow the proceedings–but have no idea how those proceedings will, er, proceed—here is a guide.

For the House to consider any major bill on the floor, the chamber needs to agree first on a procedure for debating, amending, and voting on the bill. That procedure is called a rule and, naturally, it is the Rules Committee that writes it. In most cases the Rules Committee will write what is known as a “special” or “restrictive” rule. Special rules come in all shapes and sizes, including the now notorious “self-executing” rule—the one that allows the House to pass a bill by approving the rule, rather than directly voting on the bill itself. Before debate on a bill can actually begin, the bill’s rule must get approval from both the Rules Committee and the full House.

So how is the process likely to unfold? We can’t be entirely sure of all the details yet, but it will likely start on Saturday when the Rules Committee meets, most likely in its usual room in the Capitol—a tight squeeze with just a handful of spectator seats. At that point, the committee will unveil its recommended special rule and debate it. We don’t know yet for sure what the rule will say.  There will most likely be that self-executing provision that “deems” the Senate-passed health care bill as passed by the House upon adoption of the rule or upon House passage of the reconciliation bill. 

(In theory, the rule could deem the Senate bill passed only after the Senate votes for the reconciliation package. But House Speaker Nancy Pelosi has ruled out that option, citing the parliamentary complications it would create.)

My hunch is that there will also be a provision in the rule that prohibits amendments from being offered on the floor to the reconciliation bill. In the parlance, this is known as a “closed” rule—closed that is to amendments.  Republicans relied on closed rules when they controlled the House, a practice they inherited from the Democrats who ruled before them.

Republicans on the Rules Committee will probably try to amend the rule in the committee, so that the rule is more palatable to the GOP.  But the majority party will prevail because the Rules Committee is stacked: Nine Democrats and four Republicans.  This is by design: It’s through the Rules Committee that the majority party in the House exerts much of its control. And it’s nothing new: Democrats learned to stack the committee this way from the Republicans, who learned it from the Democrats. 

When the committee completes consideration of the special rule, they will vote to report it to the full House. And that brings us to what’s likely to happen on Sunday.

When the House meets, Rep. Louise Slaughter (D-New York), chair of the Rules Committee, will call up the special rule on the floor for consideration. Typically, debate time on the rule is divided between the parties, most often for an hour. Once the allotted time is up, the House will take up what is known as the “previous question” motion.  This parliamentary move essentially asks the question: Is a majority of the chamber ready to end debate on the rule and move to a vote? (If the Senate had this seemingly obscure rule in its own rule book, we wouldn’t have that filibuster mess in the upper chamber.) If adopted by majority vote, the motion cuts off debate on the special rule.  

If the minority were to defeat the previous question motion, they would be allowed to offer their own rule for consideration of the reconciliation bill. But, for Speaker Pelosi’s sake, let’s assume that House leaders will have secured the 216 votes to approve the rule. If so, the House will then have an up-or-down vote on the rule itself.   In short, it will take two votes to actually start the debate on the reconciliation bill.  

With me so far?  The Rules Committee has now written up a special procedure for its debate and the House has approved it. If the rule is written in such a way that enactment of the rule itself deems the Senate bill passed, the Senate bill would—at that point—be ready for presidential signature. Health care reform, in other words, would be ready to become law. But it’s more likely the rule will stipulate that the Senate bill becomes law only after the House approves the reconciliation package. If so, reform’s fate will still not be settled. It will depend on whether the reconciliation bill passes.

And so the House will proceed to debate the reconciliation package, in whatever manner and for whatever duration the rule stipulates. Most likely, no amendments will be allowed.  Once debate is exhausted, the House will move the previous question motion again, this time in preparation for final passage of the bill.  Again, it will take 216 to agree to the previous question motion, setting up the climactic vote

But we’re not quite there yet.  Before legislators cast a roll call vote on final passage, the minority party is typically given the chance to offer a “motion to recommit” the bill to committee—a move that would effectively kill the bill.  It is possible that the special rule will preclude the GOP from offering that motion, which would (rightfully) outrage the GOP.  But again, we don’t know yet precisely what the special rule will say.  We do know that Democratic leaders—once they cobble 216 votes for the rule and final passage, will be eager to bring the process to a close as soon as possible. 

Finally, if all has gone according to plan for the Democrats, the chamber will come to its up-or-down vote on the reconciliation bill.  If 216 members vote yes, the reconciliation bill will go to the Senate. And the main Senate bill? That one will enter the “enrollment” process to prepare it for its journey up Pennsylvania Ave to the White House. Without a set timetable for enrollment, it is conceivable that the process will be stretched out until the Senate completes consideration of the reconciliation bill. Because this isn’t Schoolhouse Rock, we might just have to wait and see.