Washington was at a standstill this week after Republican Scott Brown won the race to replace the late Senator Edward Kennedy in Massachusetts, causing Democrats in the Senate to lose their thin 60-member, filibuster-proof majority.  Congressional leadership was relying on that majority to shepherd through health care reform legislation that Republicans in both chambers largely opposed.  The House and Senate have each passed different forms of the legislation, but will not have the opportunity to pass a combined bill without that critical sixtieth vote.  An alternative would be for the House to accept the Senate-passed bill, but House Speaker Nancy Pelosi has indicated that progressives in her party will not accept it.  The White House and Congress are now looking to pursue a pared down version of health care reform through the arcane budget reconciliation process, which only requires a 51-vote majority to pass the Senate.
 
If Congress pursues a budget reconciliation process for health care reform, it will only be permitted to consider those provisions that have a direct impact on the federal budget.  Specifically, the legislation will have to either generate revenue through new taxes, such as the proposed "Cadillac tax" on high cost insurance plans, or offer tax credits like health insurance premium subsidies for families or tax breaks for small businesses that provide coverage for their employees.  Oral health provisions that go beyond those goals are not likely to be included, such as provisions in the Senate bill to improve workforce and training and enhance prevention and surveillance.  The legislation is also unlikely to be as detailed as the authorization bills that Congress has already passed.  As a result, the requirement that qualified health benefit plans offer the pediatric oral health benefit may fall to the wayside.  To learn more about the budget reconciliation process, go to the House Rules Committee web site.  While these latest developments may not bode well for health reform, advocates should be encouraged that both the House and Senate have come out in strong support of improving oral health.
 
In the wake of the Massachusetts election, the President has called for greater bipartisanship in the effort to pass health care reform.  This latest development makes it far less likely that Congress will have an opportunity to act before the President's first State of the Union address, which is scheduled for January 27.