WASHINGTON — With solid majorities in both houses of Congress, Democrats are tempted to use their political muscle to speed passage of health care legislation with minimal concessions to the Republican minority.
That approach may be the only way they can fulfill President Obama’s campaign promises, but it carries high risks as well.
In the budget blueprint for the coming year, Democrats may resort to an obscure procedure known as reconciliation to clear the way for Senate passage of a comprehensive health bill with a 51-vote majority, rather than the 60 votes that would otherwise be needed.
“It may be a struggle to get to 60,” said Senator Jeff Bingaman, Democrat of New Mexico, who is working on the legislation.
Use of the expedited procedure, to prevent a Senate filibuster, could both help and hurt the Democrats. It would enable them to overcome Republican objections to a big increase in federal spending and in the role of government. On the other hand, it could fundamentally alter the political dynamic of the health care debate, detonating an explosive reaction among Republican senators who have been working with Democrats on the issue.
If Democrats use the fast-track procedure, it would be tantamount to “a declaration of war,” said Senator Michael B. Enzi of Wyoming, the senior Republican on the health committee.
Under the reconciliation process, the House and the Senate first agree on an overall budget blueprint and then pursue legislation — in this case, the health care overhaul — “reconciling” the blueprint with the needed policy changes. If enough Senate Democrats support the legislation, the White House would not need a single Republican vote.
The House adopted its version of the budget with the procedural shortcut. The Senate has been reluctant to authorize it, but may ultimately follow the House’s lead as the two chambers try to work out their differences.
A health care bill written mainly or entirely by Democrats would almost surely create a new public health insurance program, to compete with private insurers. It would require employers to provide insurance to employees or contribute to its cost. Employers who already offer insurance could be required to provide more or different benefits, and Congress could limit the tax breaks now available for such employer-provided insurance.
“If Democrats push a health bill through the Senate using budget reconciliation procedures, the bill would lack Republican support and would lack the support of key constituencies — certainly the business community,” said E. Neil Trautwein, a vice president of the National Retail Federation, a trade group. “Health care reform would crater for this year.”
House Democrats say the Republican protests are overheated. The fast-track procedures have been used 19 times since 1980 to pass major legislation, including much of President Ronald Reagan’s domestic policy agenda in 1981, welfare overhaul in 1996 and President George W. Bush’s tax cuts in 2001 and 2003.
The committee chairmen writing the Senate health bill, Max Baucus of Montana and Edward M. Kennedy of Massachusetts, both Democrats, have been assiduously courting business groups and labor unions, consumer groups, doctors, hospital executives and other health care providers.
Those groups — eager for a seat at the table, eager to sound constructive — have been remarkably restrained so far. They have held back in their criticism of proposals being seriously considered by Congress and the White House. But the strains are beginning to show. Labor leaders have conveyed their concern about taxing health benefits to Mr. Baucus in the strongest possible terms. Employers have warned Congress against requiring them to provide any specific amount of insurance.
Steven Kreisberg, director of collective bargaining and health care policy at the American Federation of State, County and Municipal Employees, said: “We absolutely oppose a change in the tax treatment of employee health benefits. It would endanger the current employer-based health care system at a time when we are trying to sustain it.”
Helen Darling, president of the National Business Group on Health, said, “Most of our members are big employers, and they offer health benefits, but they do not like an employer mandate.” If the government specifies a minimum package of benefits, Ms. Darling said, it could quickly become more comprehensive, without any significant cost controls.
Many lawmakers have promised to give all Americans access to the same health insurance they have as members of Congress. But the package of benefits available to Congress and other federal employees is more generous and more costly than what many private employers offer.
Mr. Trautwein said Democrats “will have a big fight on their hands” if they insist on an employer mandate. Such a requirement could be “fatal to the prospects of health care reform,” as it was 15 years ago, he said.
Mr. Bingaman said that while he was not philosophically opposed to using the expedited procedures, “the rules are pretty arcane, and there are all sort of complications.” Under Senate rules, for example, efforts to regulate the insurance industry or to improve the quality of care could be challenged as “extraneous” if they did not produce a change in federal spending or revenue.
But Rahm Emanuel, the White House chief of staff, said Democrats needed to reserve the expedited procedures as a club, in case Republicans took an intransigent stance as the “party of no.”