Health Center Federal Policy, Uncategorized

Unpacking the (Possible) Power of the Parliamentarian

By: Alex Clift

Ever heard of the Senate Parliamentarian, Alan Frumin? Not yet?550px-NCI_swiss_cheese

Well you will, if Congress decides to tackle health reform through the budget reconciliation process. If Congress does decide to legislate through reconciliation, the Senate Parliamentarian will be ultimately responsible for going through the bill with a fine-tooth comb to determine which bits and pieces of it need to come out and which can stay.

Why reconciliation? It offers a fast-track process for legislation to move straight through congress and to the President’s desk, with limited time for amendments and no 60-vote requirement. Reconciliation bills take only 51 votes to pass the Senate, so it could be passed on party lines with a few votes to spare.

Why not reconciliation? Part of the danger of policy-making through the reconciliation process is, in fact, that the bill can come out looking like legislative Swiss cheese. This is mostly down to a couple of guidelines, collectively known as the “Byrd Rule:”

1)      The bill is deficit neutral. This means that if a ten year overhaul is included in the legislation, then it has to be completely paid for in the legislation as well. The exception is that anything that’s “non-scorable” according to CBO (meaning there isn’t enough data to estimate the probably long-term savings) could be included.

2)      The bill includes no “extraneous” provisions – ie: anything not related to tax increases, spending reductions or generally reducing the deficit.  This could possibly include all the major policy changes (insurance regulations, mandates, etc) that are central to the health reform debate.

Who decides what goes into reconciliation and what doesn’t? You guessed it. The Senate Parliamentarian. Majority Leader Reid is already working with Frumin to determine what could go in the bill and what can’t, and Ranking Budget Committee Republican Gregg has prepared a list of the top 8-10 provisions that would be in jeopardy under Byrd’s rule.

The legislative process has its pitfalls, whether the Senate takes the long way around or the fast track track on health reform. The non-elected, non-partisan, no-nonsense Parliamentarian Alan Frumin can bring his 30+ years of experience with the parliamentarian’s office to bear…if he does, in fact, end up refereeing the race.


  1. Seems like MedPAC with Teeth would pass the Byrd rule, yes? That would be something…at least it could help get costs under control and set the groundwork for payment systems that promote medical homes and coordinated care.

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