Medicare Modernization Act Passed By Majority Rule

Bill Frist warns that using the budget reconciliation process to pass health reform would be a bad idea because it “would dramatically alter the founders’ intent for the Senate, and transform it from cooling saucer to a boiling teapot of partisanship.” I think it’s pretty clear that if the objection to reconciliation is that it will make the Senate partisan, then that’s no objection at all — it’s already partisan.

But Frist has a couple of other arguments to offer:

Using the budget reconciliation procedure to pass health-care reform would be unprecedented because Congress has never used it to adopt major, substantive policy change. The Senate’s health bill is without question such a change: It would fundamentally alter one-fifth of our economy. […]

In 2003, while I was serving as majority leader, Republicans used the reconciliation process to enact tax cuts. I was approached by members of my own caucus to use reconciliation to extend prescription drug coverage to millions of Medicare recipients. I resisted. The Congress considered the legislation under regular order, and the Medicare Modernization Act passed through the normal legislative procedure in 2003.

I’m not sure why Frist thinks the 2001 and 2003 Bush tax cuts didn’t constitute “major substantive change.” Indeed, in a 2006 editorial he referred to them both as “major” pieces of legislation. I think the 1996 welfare reform bill counts as major. The creation of the COBRA program, whose acronym derives from Consolidated Omnibus Budget Reconciliation Act was also major.


Last, funny thing about the Medicare Modernization Act is that it passed by a vote of 54–44 since Democrats decided not to mount a filibuster of the conference report. I think it’s pretty clear that if Republicans would promise to let a House-Senate conference committee meet to hash our a compromise under regular order and then not filibuster the resulting legislation that Democrats would happily do that rather than the reconciliation sidecar strategy.