Now or Never?
It almost seems absurd to repost information that is available in dozens of other places on the Internet, but a few folks have asked my take on the current health care endgame.
After legislative maneuvering last week that led to the excision of the so-called “public option,” the Senate Democrats have 59 of the 60 votes they need to pass a motion to end debate on the bill (known as “cloture”) and move to a vote. Assuming the bill then passes, it gets sent to a joint House-Senate conference committee where it gets reconciled with the House reform bill. The consolidated bill is then sent back to both chambers for up/down votes. In the Senate, this vote can also be filibustered.
So where is the final vote in the Senate going to come from? There are two plausible options at this point. The first is Ben Nelson (D-NE), a relatively conservative Democrat who has raised concerns about the bill’s treatment of abortion (he supported the failed Senate version of the Stupak Amendment) and the fiscal burden it would place on states.
The second is Olympia Snowe (R-ME) a relatively liberal Republican. Snowe has been concerned about the financial impact of the individual mandate and was more open to a “triggered” public option than some conservative Democrats. She has also stated that she is less inclined to support the bill if Reid tries to hold the Senate vote before Christmas. Snowe is also pro-choice, so any changes that move the bill in a more pro-life direction are not going to be much help in getting her vote.
Which Senator is more likely to come on board? Reid seems to be focusing on Nelson right now. Yesterday, Nelson reportedly rejected a compromise on the abortion language drafted by Bob Casey (David Gibson has the details). Today he spent the morning in a meeting with Harry Reid. His comments after the meeting suggest that he is still negotiating seriously. One key question is whether improvements to the abortion language would be enough to bring Nelson aboard, or whether he will use an impasse on abortion to justify a vote against a bill he clearly dislikes on other grounds as well.
Meanwhile, rage on the Left about the excision of the public option has reached a fever pitch, with Howard Dean and MoveOn.org now actively campaigning to defeat the Senate bill. Rich Trumka of the AFL-CIO has strongly suggested that the labor federation may oppose the bill, but SEIU’s Andy Stern is (somewhat reluctantly) on board. The split in labor reflects differences in their base. SEIU, which left the AFL a few years back to form a rival federation known as Change to Win, represents health care workers and low wage service workers, both of which stand to gain from reform. The AFL-CIO represents industrial and buildings trades workers who are unhappy about the tax on high-end health benefit plans.
A lot of the criticism from the Left has focused on Obama’s leadership. They think he could have done more to pressure senators and build support for a public option. I think it’s true that the White House did not have the “fire in the belly” for the public option (nor do I, for the record). I think the critics vastly overestimate, though, Obama’s ability to bring pressure on the senators who have created the most difficulty for him. Obama is relatively unpopular in places like Arkansas and Nebraska. I joked to one colleague today that the only way that Obama was going to be able to pressure Blanche Lincoln (D-AR) was by threatening to come to Arkansas and campaign for her.
What does seem clear is that Obama and the Congressional Democrats need to end this impasse soon. Obama’s poll numbers, while relatively stable in recent weeks, have fallen markedly since early in the year. Congressional Democrats have lost the generic ballot advantage they had over Republicans early in the year. If this struggle carries over into 2010, there is an increasing risk of losing Democrats facing tough re-election fights.
If health care reform does not get done in this Congress, it is fair to ask whether it can ever be done. The political parties have become more ideologically homogenous and the ideological divide between them seems to be increasing. There is now an effective 60 vote requirement in the Senate on many major pieces of legislation. Historically, the United States is a center-right country that generally embraces solutions from the left only in times of economic crisis (and sometimes not even then). The Democrats are almost certainly going to lose several seats in both the Senate and House next year, giving the Republicans an effective legislative veto. Advocates for health care reform can quibble about the details, but in terms of passing major reform, the time may well be now or never.