Bernie Sanders Explains How He'd Get 'Medicare-For-All' Passed In Congress

It involves blowing up an arcane procedural rule in the Senate known as reconciliation.

Sen. Bernie Sanders (I-V.t.) on Wednesday elaborated on his plans to pass a “Medicare-for-All” proposal in a sharply divided Congress if he wins the presidency in 2020.

Rather than back the elimination of the 60-vote threshold on legislation known as the filibuster, a move that some other Democratic presidential candidates have called for, Sanders said he would dispense with the arcane budgetary rules known as reconciliation, so Democrats could pass a bill creating a Medicare for All health care system with a simple majority of 51 votes.

Sanders discussed his plan in an interview with HuffPost on Saturday, stating, “I do think that every piece of legislation that I am fighting for can be passed with good legislative processes, including budget reconciliation.”

Under reconciliation, a piece of legislation must meet certain fiscal conditions to bypass the customary 60-vote threshold. A bill passed under those rules is forbidden from increasing the federal deficit outside a 10-year window, for example. Democrats used reconciliation to pass much of Obamacare, and Republicans did so as well to pass their recent tax cuts into law.

Sanders’ plan hinges on overruling the Senate parliamentarian, the person in charge of figuring out whether a piece of legislation meets the conditions attached to reconciliation. Given the degree of its impact on issues like health care and taxing and spending, Medicare for All would likely face a very difficult time meeting those rules. Therefore, Sanders says he would instruct his future vice president ― who also serves as the president of the Senate ― to overrule the chamber’s parliamentarian and allow the bill to pass with a simple majority.

“I can tell you that a vice president in a Bernie Sanders administration will determine that Medicare for All can pass through the Senate under reconciliation and is not in violation of the rules,” Sanders said in a new statement Wednesday.

It would be difficult in such a scenario for Republicans to overturn the vice president’s decisions. They would need to muster 60 votes to reverse him or her.

But the move would set a new precedent and potentially have an even bigger effect on how the Senate operates since it could be applied widely to other issues.

“Then anything could be subject to reconciliation,” a senior Democratic aide told The Hill in 2017 after conservatives called on the Trump administration to execute a similar maneuver. “You could authorize war with a simple majority and argue that it affects spending.”

One reason Sanders’ position on the filibuster matters is that Medicare for All entails replacing existing insurance arrangements, public and private, with a single government program that would enroll nearly everybody and set prices throughout the health care system.

It’s an audacious, politically controversial idea that got little attention in mainstream politics until Sanders made it a centerpiece of his 2016 campaign. It’s since become a rallying cry for Democratic Party progressives and, on Wednesday, Sanders introduced a newly updated version of his legislation, which 14 Democratic senators, including four fellow presidential candidates, endorse.

But even if Sanders could win over the rest of the Senate Democratic caucus (no easy task given that it includes relative conservatives like West Virginia’s Joe Manchin) and even if Democrats managed to win enough seats to reclaim the majority (also no easy task given the limited opportunities for Democratic pickups in 2020) chances are they’d be well short of 60, with little chance of winning over Republicans. That means it’d be impossible to pass Medicare for All, or really any other of his ambitious proposals, without changing Senate rules so that routine legislation could pass with a simple majority.

Sanders also called for reforms to the filibuster by requiring senators to actually speak on the floor in order to filibuster a bill. Currently, a senator can filibuster legislation or a nominee with a simple phone call.

“It is not right that one Senator can grind the entire process to a halt,” Sanders said.

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