House, Senate pass budgets, but health spending details still need OK

Washington -- The House and Senate approved their respective versions of the fiscal 2010 budget resolution early in April, just before lawmakers left town for a two-week recess.

The House passed its $3.55 trillion version of the budget resolution by a vote of 233-196 during the evening of April 2. The Senate approved its $3.53 trillion budget resolution by a vote of 55-43 later that evening. If Congress can agree on a final version, it will serve as a blueprint for lawmakers' spending priorities but will still require them to approve legislation that authorizes the spending.

When they return from recess the week of April 20, lawmakers will begin ironing out differences. Both measures contain a health care reserve fund to make room in the budget for a major system overhaul, but neither includes details on how that reform would be accomplished.

Some of the more notable differences between the versions are on the use of a tactic called reconciliation and "pay-as-you-go" conditions that could have a significant impact on the health reform debate. Both items were included in the House budget resolution, but not in the Senate's.

Pay-as-you-go budget rules compel lawmakers to find offsets that will fully pay for rate changes or other spending priorities rather than run up deficit spending. A Medicare physician payment adjustment normally would be subject to these conditions as well, but a provision in the House budget would effectively suspend pay-go rules for a 10-year payment overhaul that costs up to $285 billion. That way lawmakers would need only to find offsets for any reform costs exceeding that amount. The exemption, if it survives the negotiations, could make it easier for lawmakers to pass a payment overhaul.

GOP lawmakers have expressed concerns that Democrats will use the reconciliation process to muscle health reform plans through Congress. If reconciliation instructions for health reform in the House budget survive negotiations between the two resolutions, Senate Democrats could opt to pass major reform with only 51 votes instead of the 60 usually needed to end debate. Republicans also would be limited in the number of amendments they could offer. The process is normally reserved for deficit-reduction legislation but has been used to pass unrelated measures.