Is it reconciliation? Or penance?

Examples of Republican hypocrisy (or lunacy, to be charitable) on health care (and almost any other topic important to the nation's well-being) are too numerous to cite. Hey, it takes Andrew Sullivan and a small staff all day every day just to keep up!But here, courtesy of NPR, is a keeper that's worth a mention ahead of tomorrow's health care debate:

"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.For example, the law that lets people keep their employers' health insurance after they leave their jobs is called COBRA, not because it has anything to do with snakes, but because it was included as one fairly minor provision in a huge reconciliation bill, she says."The correct name is continuation benefits. And the only reason it's called COBRA is because it was contained in the Consolidated Omnibus Budget Reconciliation Act of 1985; and that is how we came up with the name COBRA," she says.COBRA, which confusingly did not become law until 1986, was actually a much larger bill, including many nonhealth provisions and many other important health provisions as well (see chart). Among them was the so-called Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals that accept Medicare or Medicaid payments to at least screen patients who arrive for emergency treatment, regardless of their ability to pay.But the budget reconciliation process has been used for more far-reaching health policy changes as well, says Rosenbaum. The expansion of health insurance coverage for low-income children is a prime example......."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......In fact, over the past three decades, the number of major health financing measures that were NOT passed via budget reconciliation can be counted on one hand.

Hat tip toKaren Tumulty at Time's Swampland blog. Tumulty notes thatreconciliation for COBRA, for example, was used when Republicans controlled the Senate and the White House.Not to worry. They'll be so focused tomorrow discussing details of the GOP plan to fix health care by...well, that's a tough one to answer, isn't it?

David Gibson is the director of Fordham’s Center on Religion & Culture.

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