The House Passed the Overhaul — Now What?

So, now what?

Relieved Democrats may still be celebrating the passage of landmark health care overhaul legislation, but Republicans in the Senate still have an opportunity to try to kill the bill.

And if history is any guide, they are likely to force the House to vote on health care again before Easter. "Anybody that thinks that this is only going to be a one-time deal today in the House, I think, is grossly mistaken," said Republican Sen. Orrin Hatch on CNN's "State of the Union."

Late Sunday, the House passed the Senate's version of the comprehensive bill, and because most members didn't like it, they also passed a smaller bill of so-called "fixes."

Passing of those subsequent fixes was a critical component to passage of the Senate bill for House Democrats.

Without them, House Democrats would have been supporting a bill with elements deemed largely undesirable. A promise by Senate Majority Leader Harry Reid that the Senate would work to approve the package of fixes coaxed "yes" votes from many Democratic lawmakers who had previously indicated they might oppose the Senate bill.

On Tuesday, the Senate is expected to start their work on the fixes bill using a little-understood procedure known as reconciliation.

For Democrats, reconciliation is the perfect antidote to what they feel is Republican obstructionism in the upper chamber. The process is filibuster-proof, requiring only 51 votes for final passage rather than the usual 60 to overcome a blockade by the minority party.

For Republicans, reconciliation is their best chance to kill the smaller bill or make changes to it. Because the House and Senate must pass the same bills — word for word — even a minor tweak would send it back to the House for another vote.

Republicans hope to force major changes to the reconciliation bill, some that could set up a political nightmare scenario for Democrats. If certain unpopular provisions of the Senate’s version of the bill — like special carve-out deals for individual states — are not corrected, Democrats risk being branded as supporters of back-room deals. And if Republicans manage to scuttle reconciliation language that would delay the implementation of new taxes on high-value insurance plans, union groups who were counting on the fix will be incensed.

In the 22 times reconciliation that has been used, only once has the Senate bill not been changed and sent back to the House.

Reconciliation's basic rules
Reconciliation is a fast-track legislative process specifically designed to reduce deficits. Debate is limited to 20 hours, but an unlimited amount of amendments can be offered and voted upon.

Every line in a reconciliation bill must adhere to strict rules to ensure a budgetary impact or else risk being eliminated by the non-partisan Senate parliamentarian. Here lies the biggest opportunity for the GOP.

Cutting up the bill
To ensure that all provisions of the bill have a budgetary impact, the rules of reconciliation allow Republicans to raise 19 different types of objections.

The most commonly used objection (also called a "point of order) is known as the “Byrd Rule,” named after its author, West Virginia Sen. Robert Byrd.

This can be raised against any part of the reconciliation bill that does not address budgetary matters. The extraneous matter would be removed from the bill if the parliamentarian, Alan Frumin, upholds that point of order.

"House Speaker Nancy Pelosi's reconciliation fixes could easily be blown to pieces in the Senate," Sen. John McCain, R-Ariz., said on the Senate floor last week.

Reid can ask for a vote to overrule the parliamentarian, but it would take 60 "yes" votes in most cases. With the election of Massachusetts Republican Scott Brown in January, Democrats only have 59 votes in their caucus.

There are also other rarely-used points of order which could be used to effectively kill the entire bill.

Amendments to the bill
Adding new elements to the bill would also send it back to the House for another vote.

Under reconciliation, an unlimited number of amendments can be offered by Democrats or Republicans. Republicans haven't tipped their hand on strategy, but have made it clear they will offer dozens.

Republicans say the rules will allow them to offer a broad array of amendments. The topics could include anything within the jurisdiction on the two Senate committees that produced the health care bill: finance and health (which also includes education, labor, and pension issues).

New Hampshire Republican Judd Gregg has encouraged his GOP colleagues to submit amendments that are "serious and relevant," according to an aide. "I can't say there will be no crazy immigration stuff because we never can tell what certain people will do," the aide said.

Such a wide open field could require Democrats to make some tough votes on hot button issues like taxes, Medicare cuts, Medicaid, immigration, and labor. This could prove especially problematic for those Democrats facing re-election.

Democrats say they'll ask the parliamentarian to rule that Republicans are being "dilatory" or delaying the process by offering too many amendments. Multiple Republican sources have suggested they're more interested in quality than quantity.

"You can be serious and relevant for a long time," the GOP aide said. "I think there's plenty of issues that can be covered without treading into that dilatory area."

Votes of the amendments would likely come at the end of the debate in what is called the "vote-o-rama."

The parliamentarian
It's clear the process puts a lot of power in the hands of the parliamentarian.

He alone rules whether something should be eliminated from the bill or if or if Republicans are employing stalling tactics. (The Democratic senator presiding over the Senate at the time, which could be Vice President Joe Biden, can chose to ignore Frumin's advice, but aides say Senate leaders will respect the parliamentarians rulings.)

Many of the tough decisions have already been vetted in advance. Republican and Democratic staff have already met with the parliamentarian individually, but as of Friday morning, have not met together to see what provisions are most likely to be struck from the bill.

"Nobody wants to surprise anybody if we can avoid it," Gregg said. "The parliamentarian deserves to have a reasonable amount of information so that he can make a thoughtful decision and is not having to take action in a situation where he hasn't had time to analyze the issue."

While the parliamentarian doesn't issue final verdicts, both sides are likely to get an early sense of which way the procedural winds are blowing.

This may reduce the risk of some "gotcha" moments on the floor, but not eliminate them completely. Republicans say they'll comb through the bill until the last moment looking for holes.

"As we come across provisions in the bill — be it before we get on the floor or on the floor — at anytime we can go down to the parliamentarian to make our case," said a Republican aide well versed in reconciliation strategy.

Democrats sheepishly admit that changes to the bill are possible. But they believe those changes would be minor and not have a significant impact on the substance or cost of the bill.