A guide to the shifting political factions in the health care debate.

A guide to the shifting political factions in the health care debate.

A guide to the shifting political factions in the health care debate.

Who's winning, who's losing, and why.
Nov. 13 2009 7:15 PM

Win Some, Lose Some

A guide to the shifting political factions in the health care debate.

President Obama on Sunday celebrated the House's passage of health care reform with a vivid metaphorical message to the other side of the Capitol. "Now it falls on the United States Senate," he said, "to take the baton and bring this effort to the finish line on behalf of the American people." He wishes this were as simple as a relay race. The legislative process does work in stages, it's true, but in other ways, the president's metaphor falls apart. First, the competitors aren't running in the next lane. They're rolling out hurdles (or gurneys, as the case may be). Second, the runner who just finished the first leg is now trying to tackle the guy with the baton.

On Monday, less than 48 hours after the House passed the historic universal health care bill in a squeaker, 40 House Democrats pledged to reverse their support for reform if language restricting abortion rights was not removed. That'll be tricky. House leadership aides say the abortion measure, known as the Stupak-Pitts amendment, was crucial to the 220-215 victory. Without it, Speaker Nancy Pelosi would have lost as many as 40 votes.

John Dickerson John Dickerson

John Dickerson is a Slate political columnist, the moderator of CBS’s Face the Nation, and author of Whistlestop and On Her Trail

Perhaps the better metaphor for the process is the old one about a bump in the rug: When you push down one bump another appears somewhere else (often on cable TV). "There are members on the right who will peel off if we do too much to satisfy people like me," says Rep. Anthony Weiner of New York, "and there are those on the left who will peel off if we do too much to accommodate the likes of Joe Lieberman."

The bumps related to abortion aren't the only ones in the process. The Senate must now pass its own bill. Senate Majority Leader Harry Reid will have to build the kind of coalition Pelosi just did (except unlike in the House, where the parents can discipline the children, in the Senate there are no parents). Then, the two bills are melded in a conference committee and both chambers must vote on the final mélange. That leaves lots of time for mischief. Herewith, a guide to some of the shifting factions in the health care debate:

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  • House pro-choice caucus: Forty members wrote to Pelosi arguing that the Stupak amendment "represents an unprecedented and unacceptable restriction on women's ability to access the full range of reproductive health services to which they are lawfully entitled. We will not vote for a conference report that contains language that restricts women's right to choose any further than current law."
  • House supporters of the Stupak-Pitts amendment: 41 House Democrats voted to support the Stupak amendment, restricting abortion funding, who also voted to support the ultimate legislation.
  • House public option holdouts: Dennis Kucinich is the most notable person in this category. He voted against the House health care bill because it did not include a sufficiently large government component. Weiner says that he has talked to other Democrats who say that while they voted for the House bill, they will not vote for the final conference bill if the public option is not included. The public option is likely to get weaker coming out of conference (in order to win Senate approval), but House leadership aides don't take the public option threats as seriously as they take the threats from those who have objections over abortion.
  • House Democratic "no" votes: Thirty-nine Democrats voted against health care reform in the House. The vast majority did so because they had concerns about the bill's cost or the public option. If and/or when the House bill is melded with the Senate version and it contains greater cost saving measures or a weaker public option, then Pelosi might be able to pick up some of these votes. The downside is that doing so would almost certainly cause defections among liberals.
  • Hispanic caucus: The Senate health care bill includes a provision barring illegal immigrants from purchasing insurance through the government insurance exchanges created by the legislation. The House bill does not include such a provision. If the bill that emerges from conference is too close to the Senate measure, Democratic leaders expect to see threats of defection from Hispanic members.
  • Senate moderate Democrats: Ben Nelson of Nebraska, Blanche Lincoln of Arkansas, and Mary Landrieu of Louisiana are worried about cost and don't like the public option that Reid has included in the Senate version of health care reform. Nelson is strongly pro-life and is likely to offer his own version of the Stupak amendment. Unless Reid can find a few Republicans, he'll need these Senators to get to 60 votes.
  • Senate liberals: If Reid accommodates moderates on abortion or the public option, will he lose Sen. Jay Rockefeller or Bernie Sanders, an independent?
  • Joe Lieberman: An island unto himself. He will vote with Democrats to start debate but has promised to filibuster any public option.
  • Senate Republicans: Olympia Snowe and Susan Collins. They are "no" votes for the moment but say they are still open to compromise.
  • The anti-tax senators: "We don't tax rich people," joked one Senate veteran when discussing the House provision for funding reform through a surtax on incomes of $500,000 or more. One reason: Senate campaigns are expensive and require donations from lots of people who make $500,000 or more.
  • Anti-tax House members: The Senate plan to put a 40 percent tax on high-cost, "Cadillac" insurance plans has very little support among House Democrats, in large part because it is unacceptable to their union supporters.

Before the House vote last Saturday, Obama made two key political points to Democratic House members. First, they needed to vote for health care because it would motivate the party base in 2010. Second, those who think they can run away from the president by voting against his signature legislative effort are kidding themselves. The president believes that a key lesson of the Republican rout of Democrats in 1994 was that Democrats who oppose their president can never get far enough away to survive politically. So if you're going to get stuck defending the president, you should get behind his plan and benefit from the political cover he'll work to give those who support him.

That argument worked well enough to get through this leg of the race. But it remains to be seen whether it will be enough to keep a coalition together through the end of this process—whether it resembles a relay, a three-legged race, or an egg toss.

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