In a bid to move these issues, House Democrats inserted into their version of a budget bill the option of a fast-track process called reconciliation.
If deftly used -- that means getting past complex procedural objections -- it can squash a Senate filibuster and move big bills on a simple majority vote.
"We want a robust [healthcare] initiative about prevention, about biomedical research, about health IT, about community health centers reaching out, personalized, customized care," said House Speaker Nancy Pelosi at a briefing on Thursday. "I think the best prospect for that to happen is to do it under reconciliation."
No issue so inflames partisan passions, especially in the Senate where the standard of 60 votes for major legislation is now the norm.
Democratic power play?
"If they want to steamroll the minority, obviously, some kind of reconciliation vehicle would be the best way to do that," said Senate Republican leader Mitch McConnell. "However, it's a big gamble, because if you do it with no bipartisan buy-in at all, you own the whole thing politically."
The scenario would play out like this: The House passes a budget bill with reconciliation instruction; the Senate does not. But House and Senate conferees agree to include reconciliation in the final version of the budget resolution -- without the issue ever being debated on the floor of the Senate.
Anticipating this move, 33 senators -- eight Democrats and 25 Republicans -- sent a letter to the Senate Budget Committee earlier this month urging that reconciliation not be used to enact clean energy reform.