The Senate version of the health care bill, H.R.3590 passed yesterday. Unfortunately, it does not contain the provision to extend Medicare coverage for immunosuppressive drugs after a kidney transplant that transplant advocates, including me, supported. But it also does not contain the provision to reduce payments to dialysis centers which was lobbied against by the Kidney Care Partners. The House version of the bill H.R.3962 contains both provisions. My guess is both provisions are now dead and will not appear in the reconciled bill.


While reading the Senate bill, I noticed that the opening paragraph says this:

“To amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes.”

What’s up with that?

Well, if you remember your high school civics classes, only the House can start a revenue bill. To get around that proscription, the Senate just takes an existing House revenue bill, strikes all of the content except the enacting clause, and replaces it with their desired content.

Here’s another interesting tidbit I learned. While the Senate bill was being debated, the Democrats worried that the GOP would block the bill using a filibuster, in which opponents of a bill prevent it from coming to a vote by not yielding the floor. To prevent that, they used a cloture vote which stops all debate. This vote requires a three-fifths majority (60 out of 100) to pass, which the Democrats hold. To see how divisive politics has become in the U.S., look at the graph below showing how more frequent cloture votes have become in the past year.


Frequency of Senate cloture votes by biennial terms. Image from Wikipedia

The above chart could be made more informative by indicating the ratio of Democrats to Republicans in the Senate each year and which party held the House of Representatives. My guess is that cloture votes are much more likely when the ratio is close to 60-40 and the majority party in the Senate also holds the House. That’s because when the minority party is weak, the threat of a filibuster is one of the few tools it has available to modify legislation. And when the ratio is close to 60-40, there is some uncertainty whether there will be enough votes to stop the filibuster.