Chris lays out the timeline:
In order to pass the bill by the Easter recess, and avoid any further delays that could sink the bill, the Senate needs to take up the bill next week.
In order for the Senate to take up the reconciliation bill next week, President Obama has to sign the Senate bill into law before he leaves the country for a five day trip on Sunday.
In order for President Obama to sign the bill into law before he leaves the country, the House needs to pass the bill by Saturday night.
And, in order for the House to pass the bill by Saturday night, the CBO needs to release its score of the bill tonight, 72 hours before the House votes.
The CBO report is expected today, and has to happen today to meet the deadline. Of course, missed deadlines are the process hallmark of this bill, so perhaps history is against Congress on that one. Jon Cohn describes the big hold-up.
In order to satisfy the requirements for the budget reconciliation process, through which Congress will consider the amendments, CBO must certify that the changes will reduce the deficit both in the decade following enactment and the decade following that.
By "reduce the deficit," I mean reduce the deficit relative to whatever the Senate health care reform bill would do on its own. And that is no small thing. The Senate bill, as written, was projected to save quite a bit of money. As such, the amendments must result in reform, as a whole, saving even more money than the CBO projected originally.
Accomplishing that in the first decade isn't so difficult. Basically, you figure out how much money it costs to improve the subsidies, to fill the Medicare drug donut hole, and to scale back the benefits tax. Then you increase the Medicare tax and maybe take a little more money out of the pockets of industry groups. It's more or less as simple as taking from column A and then pulling an equal amount, plus an extra billion or two, into column B.
But the second decade, apparently, is another story. Officials and staff aren't saying what the hang-up is; CBO, as a rule, doesn't comment. But it's safe to assume that it has something to do with the fact that small changes in the first ten years become much bigger changes in the second ten years, because of compounding effects. Remember, if you give people more financial protection against illness--a major goal of the amendments, not to mention reform as a whole--the economic models predict that, all else being equal, those people will consume more health care and, thus, spend more money. If revenue and savings don't keep up--don't forget, the Medicare tax doesn't rise with medical inflation the way the benefits tax does--then a financial gap will open up.
You know what would do that budgetary trick, what could save the feds as much $110 billion over ten years? That's right, a robust public option. And they could save $25 billion with the public option the House already passed. Go figure.