Health-Care Passes the House, But Now Comes the Really Hard Part


Health-Care Passes the House, But Now Comes the Really Hard Part

On Saturday morning, about 12 hours before the U.S. House of Representatives passed sweeping legislation to expand health-care coverage to almost all Americans, President Barack Obama did what he does best: He gave an inspirational speech meant to rally recalcitrant House Democrats. Many in the room credited Obama with swaying the last of the fence sitters. “A few members that were leaning no told me afterwards that they’d been moved to vote yes,” Rep. Rob Andrews, a New Jersey Democrat, told reporters after the meeting.

Obama spoke of doing something greater than yourself. He asked House Dems to join him in “bending the arc of history,” a phrase he first invoked in his election victory speech a year ago before 125,000 people in Chicago’s Grant Park. And though there was cheering and chants of “Fired up, ready to go!”, this was no easy sell for Obama. The vote came the same week as Democrats lost the Virginia and New Jersey governors’ mansions, and a day after the Labor Department reported a 26-year record unemployment rate of 10.2%. Preaching altruism in such a climate to politicians bent on self-preservation is tough. In the end Democrats lost 39 of their own – passing the bill 220-215 with a cushion of just two votes, one of those a Republican in a heavily-Democratic Louisiana district.

Democrats on Capitol Hill spent some of the aftermath congratulating themselves on their historic achievement, but they knew as well as anyone that it was far too early to really celebrate. Obama’s speech, after all, was strikingly partisan, lambasting the GOP for doing nothing more than “saying no, stopping progress, gumming up the works.” That change in tone from his fruitless attempts at outreach ten months before in the run-up to the stimulus vote made it clear that Democrats are now resigned to going it alone both in the House and the Senate. Majority Leader Harry Reid has moved away from the lone Republican still negotiating on health care, Maine’s Olympia Snowe, and toward a plan to pass the bill relying solely on Democratic votes, of which he’ll need every one in order to overcome the threat of a filibuster by Republicans.

“Democrats voted for the bill and a Republican voted for the bill. That is bipartisan,” Pelosi told reporters at a midnight victory press conference to laughter. “We’re proud to take responsibility — and credit — for the [bill] passed largely on Democratic votes. What we always try to do is to find common ground and tonight we’re very excited about what we have done.”

But the House vote showed just how hard it is for Congressional Democrats to pass anything on their own: the bill was nearly brought down by last minute objections from 64 pro-life Democrats who wanted to tighten restrictions to ensure that no federal funding of abortions could possibly occur as a result of the reforms. Likewise, in the Senate, Reid’s toughest task in the coming weeks will be to convince moderate Dems to vote for a bill that includes a public alternative to private insurers in order to help keep down costs – a provision that Republicans have criticized as the first step to socialized medicine, and several key Democrats are wary of. Citing his concerns for the impact on the federal deficit, Senator Joe Lieberman of Connecticut told Fox News on Sunday that “If the public option plan is in there, as a matter of conscience, I will not” support the bill. The Senate is waiting on a Congressional Budget Office cost estimate this week before they bring up the bill. Reid’s office is hoping to start floor debate as early as next week.

Even if Reid manages to get his bill through by the end of the year, he’ll then have to confront the messy prospect of merging it with the more liberal version passed by the House. But in some respects, the thorny details of the process have become almost secondary to the larger goal; Democrats are betting that they were elected on a platform of change, and they argue that health care is the first true piece of their platform, given that they have had to spend the first months of Obama’s presidency dealing with the economic ruins of Bush’s reign. “The Democrats have no choice but to do it on their own” said Thomas Mann, a senior fellow at the Brookings Institution. “And at this point, their political survival depends upon legislative success, if need be with only Democratic votes.”

Still, they aren’t blind to polls that show that voters see all of Washington’s work running together: auto and bank bailouts, massive budgets, record deficits, stimulus, climate change and now a $1.1 trillion health care bill. Worse yet, the odds of a jobless economic recovery are looking increasingly likely. But Dems don’t feel they have much of a choice, having concluded that doing something is better than supporting the status quo. “It is the third anniversary of Democrats winning the House and Senate for the American people – November 7, 2006,” Pelosi told reporters Saturday morning. “So it is appropriate that the New Direction that we promised them at the time and that we have worked on since then, will be manifested today in the passage of this important legislation.”

Republicans have taken heart in last week’s elections showing independent voters swinging their way – even though their strategy has involved little beyond saying no. Their 209-page health care alternative, produced less than a week before passage of the Democratic bill, was widely panned as a flimsy attempt at cost curbing that did little to expand coverage and almost nothing in the way of new protections, such as those for consumers who have pre-existing medical conditions. The risk is at least as great for Republicans. “The small bore, crabbed and nearly meaningless reform plan they produced in the House after months of nothing but complaining about the Democrats just reinforces the notion that they are a Party of No,” said Norm Ornstein, a fellow at the conservative American Enterprise Institute.

Midterm elections, however, are rarely about the merits of the opposition. Democrats will be ready to trumpet health care reform if it passes, but it’s not clear that will be enough to sway voters, who rank jobs and the economy as their most important issues. “Five or ten years from now, maybe, this bill will seem as a success, who knows” says Charlie Cook, editor of the non-partisan Cook Political Report, which tracks congressional races. “But I don’t think it will give Democrats a lift next year.” Perhaps. But most Democrats, led by President Obama, aren’t eager to see what kind of lift the Republicans will get if the Democrats can’t use their majorities to pass the priority they haven’t stopped talking about for the past year.

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