Two senior administration officials said the White House is telling Democrats reconsidering their support for health care reform that they will pay the price for their original vote no matter what happens, so they should reap the political benefits of actually passing a law.
There are 59 senators and 216 House members who put themselves on the record in support of the Democratic plan for health care reform. And the way the White House and Democratic leaders see it, they have little choice but to vote for it again: Think John Kerry, and his immortal words about an Iraq war appropriations bill – that he was for it before he was against it.
“Flip-flopping is dangerous in this business,” said a senior Senate Democratic aide familiar with the strategy.
Speaking in the East Room of the White House to a room full of doctors and nurses, many in hospital scrubs and white coats, President Barack Obama did not touch on such political realities. Instead, he signaled the kind of personal involvement in pushing the legislation over the next few weeks that has been absent – at least publicly – since the upset victory of Sen. Scott Brown in the Massachusetts special election in January ended the Democrats’ filibuster-proof majority and put health care in doubt.
Kicking off what he promised would be an aggressive campaign, Obama called on Congress to schedule a vote, saying the time for talking is done. And without saying the word “reconciliation,” Obama made it clear that he¹ll pass legislation with only Democratic votes if necessary.
The president laid down a timetable that would wrap up the bill before the Easter break in Congress as well as a Democratic line of attack: We’re not passing health care in a backroom deal because it has already passed in both the House and the Senate under the traditional rules. All that’s left now is the cleanup.
“The American people want to know if it’s still possible for Washington to look out for their interests and their future,” Obama said. “I don¹t know how this plays politically, but I know it’s right. And so I ask Congress to finish its work, and I look forward to signing this reform into law.”
Congressional leaders continued Wednesday to lock down a strategy on the process, timing and substance of the bill, aides said. The next major step will be to send the reconciliation bill to the Congressional Budget Office for a cost estimate, which could take days or even weeks to finalize.
House leaders, meanwhile, started the process of smoothing opposition to a finished package. Speaker Nancy Pelosi met Wednesday with New York Democrats in her office off the House floor to assuage concerns about the Medicaid expansion.
Since New York already subsidizes more people under Medicaid than most states, it is slated to get less federal aid than states that will be forced under the bill to expand their Medicaid rolls to people with incomes 133 percent above the poverty line – a standard New York already meets.
And quietly, behind the scenes, White House officials and leaders began the critical task of shoring up support.
The House will be asked to cast two more votes – the first on the Senate bill, which contains many elements that liberal members detest, and the second on a package of fixes. The Senate will only have to vote on the second bill through reconciliation, which allows passage with a simple majority rather than 60 votes.
As Democratic leaders urge lawmakers not to reverse their initial vote for the bill, they need to make the opposite case to the 39 House members who opposed reform on the first go around. Neera Tanden, a former health policy aide in the Obama administration, laid out the pitch in a colunm posted Wednesday on The New Republic website.
“As a matter of policy, the Senate bill is a moderate Democrat’s dream,” Tanden wrote. “House moderates have to ask themselves, apart from political considerations, how can they now vote against a bill that senators Lincoln, Lieberman, Landrieu and Bayh have all voted for?”
Sen. Blanche Lincoln of Arkansas said she doesn’t buy the argument on flip-flopping.
She is perhaps the Senate’s most endangered Democrat, facing a primary challenge from the left and, if she survives that, a general election fight from the right. She drew a distinction between her vote in favor of the Senate bill and her opposition to the reconciliation measure.
“I wouldn¹t be voting against the Senate health care bill,” Lincoln said.
“The Senate bill will be what the House passes. Ive been supportive of the Senate bill.” The reconciliation measure “would be a whole other bill,” she said.
Missouri Sen. Claire McCaskill, who has remained undecided on the reconciliation measure, said the argument doesn¹t hold merit because lawmakers aren¹t voting on the same bill. But, she added, lawmakers need to stop looking at the issue through such a political lens and at how their actions will play “politically.”
“You know, there is a substance here that is really important,” she said.
“I’m just so sick of this place and it all being about power and elections and not about people out there. We really need to get beyond the ‘politically’ part.”
Sen. John Rockefeller (D-W.Va.) said he expected the White House to argue to Democrats that they can¹t turn against their vote now.
“It sells itself,” Rockefeller said. “That is an argument I am comfortable with because it needs to be made.”
Distrust of the Senate is a problem for some House members and could make it hard for any Democrat to vote for the Senate bill unless he or she has absolute confidence that Majority Leader Harry Reid and the president will apply their changes through the reconciliation process.
“Fool me once, shame on you. Fool me 290 times, shame on me,” said New York Rep. Anthony Weiner, an always quotable backer of the most sweeping reforms.
“Most things the Senate said they would do, they haven¹t done. There are too many deficiencies in the Senate bill for us to go on faith.”
Democrats, no matter how they vote, are expected to come under Republican attack.
House Republicans announced their own latest effort to pressure potential swing votes: “Project Code Red,” which will highlight everything the Democrats say on the issue of health care and make sure GOP candidates running against them back home respond.
And Senate Minority Leader Mitch McConnell (R-Ky.) predicted “every election in America this fall will be a referendum on this issue.”
The political dynamics put lawmakers like New York Rep. Michael Arcuri, who voted for the initial House bill, in a bind. He expressed frustration with the Senate measure and gave every indication that he’s prepared to vote against the final package; his only caveat was that he hadn’t seen the finished language.
“What I have seen so far, I don’t like the bill,” Arcuri said. “The House bill really accomplished something. It was a tough vote, but I thought it was the right thing to do. I don’t see how the Senate bill will do the kind of things I want to do with health care. It¹s not what I¹m going to support at this point.”
Arcuri complained that the Senate bill lacks a public option, fails to dissolve an antitrust exemption for health insurance companies and won’t allow the federal government to negotiate drug prices under Medicare. He also opposes the tax on high-end health care plans.
His distaste for the Senate bill is hardly unique, but many of his House colleagues signaled a willingness to back an imperfect product over no product at all – a calculation the White House is counting on, in part, because flipping now would be politically perilous.
In the weeks ahead, undecided Democrats will be asked to weigh their objections to parts of the final package against a historic opportunity to provide health insurance to as many as 30 million Americans who currently lack it.
Connecticut Rep. Joe Courtney, an outspoken opponent of the Senate¹s tax on high-end health care plans, doesn¹t like seeing the so-called Cadillac tax in a finished bill. But he¹s not sure that this alone is reason to vote against a final product.
“Obviously, this is a generational moment,” Courtney said. “It¹s a long time ago before the forces built up again. So this is nothing to be trifled with in terms of that opportunity.”
First-term Virginia Rep. Gerry Connolly acknowledged that the bill he will have to vote on represents what he called “³the last best chance, and I’m very aware of that, very, very aware of that. So I certainly feel that burden.”
“Could I have a different vote on this bill than I had on the previous one? Absolutely,” said Connolly, who voted for the initial House bill.
“It’s a different bill. Am I likely to be a changed vote? Well, we’ll have to see. I believe we need health care reform. I am passionately committed to that. I think it¹s a terrible missed opportunity to let this slip through our fingers.”