House members may pass health care reform legislation without having the opportunity to vote on it. House Speaker Nancy Pelosi suggests she might use a tactic known as a self-executing rule, or deem and pass. This procedure has been commonly used on legislation of lesser impact. Pelosi says she prefers it because it would politically protect lawmakers who are reluctant to publicly support the measure. Republicans quickly condemned the strategy, framing it as an effort to avoid responsibility for passing the legislation, and some suggested that Pelosi's plan would be unconstitutional.
Here is how the procedure would work. The House would vote on a more popular package of fixes to the Senate bill; under the House rule for that vote, passage would signify that lawmakers deem the health-care bill to be passed. A 1998 Supreme Court ruling states that each house of Congress must approve the exact same text of a bill before it can become law.
House Democratic leaders say they are having a problem coming up with a bill at an acceptable official cost estimate. The bill has been sent back to the Congressional Budget Office more than once. But Majority Leader Steny Hoyer, D-Md., says they continue to plan a final vote this week. The Democratic leadership was expected to finish final language of a package of amendments to the Senate-passed health care bill Tuesday night.
In the Senate meanwhile, Senators Chuck Grassley, R-Iowa, and Mike Enzi, R-Wyo., are asking the chief actuary for the Centers for Medicare and Medicaid Services to provide a complete analysis of health care reform legislation before the House and Senate vote on the legislation. The Senators say the analysis they are seeking is critical because the chief actuary looks broadly at the legislation's effect on national health care spending, access to health care and the economy. In contrast, the Congressional Budget Office focuses solely on federal health care spending.
Grassley and Enzi are the ranking members of the Finance and Health, Education, Labor and Pensions committees. In a prepared statement the two Senators said that legislation that affects such a significant segment of the economy and touches the lives and wallets of every American deserves the thorough analysis that the chief actuary would provide.
A previous analysis from the chief actuary showed that the Senate health care reform bill would increase health care spending, limit access and reduce quality. Grassley and Enzi said members of Congress should know whether any of those issues were addressed before being asked to vote on health care reform again.