As the House and Senate close in on a health care reform vote, its end game has turned into a fight over the politics of process, not the substance of the policy itself.

Democratic leadership's plan is for the House to pass the Senate bill with changes under budget reconciliation rules and send the new bill back to the Senate for final passage. However, while issues over the future of the health care system typically are deliberated in the major committees of jurisdiction over health care matters, the current debate is taking place with House and Senate leaders, the Senate parliamentarian, and the House Rules Committee offices.

House leaders are working to structure a rule to “deem” the Senate bill passed upon passage of a companion corrections bill that makes changes to the underlying Senate version. All the bending is intended to avoid putting House Democrats in a position of voting on the Senate bill directly, which contains many unfavorable provisions, including the special deals negotiated for individual Senators.

The House Rules Committee is expected to meet today after the House Budget Committee passed procedural hurdles on Monday for the use of budget reconciliation. Meanwhile, the Committee will not advance until the Congressional Budget Office (CBO) releases its budgetary analysis of the new bill with its changes.

Neither the CBO score nor the specific details of the companion corrections bill have been made public as of press time. The CBO last week updated a previous analysis of the Senate version. They noted it would spend $875 billion to provide coverage for 31 million uninsured people over the next 10 years. The cost, it said, would be more than offset by new taxes and fees and by cutbacks in Medicare, so the bill would reduce budget deficits by a total of $118 billion over 10 years.

The Senate Parliamentarian and others have voiced skepticism as to whether it would be kosher to “deem” a bill passed with a companion corrections bill before the bill itself is signed into law. Meanwhile, the Senate has been sidelined while the House wrestles with its process. However, Senate Republicans have been made aware that the chamber will consider the House changes under the budget reconciliation process.

The House Rules Committee is expected to wrap up their business today or tomorrow, giving House members the 72 hours promised by Speaker Nancy Pelosi (D-Calif.) to review the final bill before a vote. The vote is expected to take place Friday night at the earliest.

The politics over process has overshadowed the linchpin in the debate, which is the votes needed to pass a measure. While Senate Democrats seem to have the 50 votes necessary to send the bill into a tie-breaking vote for Vice President Joe Biden, House Democrats are reportedly short on the necessary 216 votes needed for passage. Conflicts over the inclusion of abortion and immigration language, as well as the potential for other provisions to be subject to the “Byrd” rule – thereby preventing its inclusion – continue give vote counters headaches.

Even though health care reform has unfolded into a chaotic state, NSBA remains committed to being a pragmatic voice for small business. NSBA’s advocacy remains focused on reducing cost and increasing coverage through individual responsibility and empowerment, creating the right market-based incentives, and a relentless focus on improving quality while driving out unnecessary, wasteful, and harmful care.

Stay tuned to the NSBA Web site for more information on the final health care bill. Also check back with NSBA Health Reform Today Web site as more information is made available.