Democrats Struggle to Move Forward on Healthcare

Kent Garber

Pelosi promised to pass 'something' and Obama urged Democrats to press on

"Shell-shocked" is the way Democrats kept describing their reaction to Scott Brown's election victory in Massachusetts. Hill aides sounded weary and uncertain. Gone was the hope that healthcare reform was close to clearing its last hurdle. Gone was the sense of inevitability that had sprung up around the effort.

In its place were hastily arranged private meetings convened by Democratic leaders. House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid spent the day rotating among caucus members. They were "assessing," "re-evaluating," doing damage control.

Senate Democrats gathered around for their first meeting of the new year, a regularly scheduled weekly lunch, but the mood and agenda were clearly different. "Every member of the caucus, as individuals and as a group, is trying to read the tea leaves," said a Senate Democratic aide. "Members are concerned."

Democrats are still trying to decide what to do: push forward, back down, or take a new approach to salvage healthcare reform, the centerpiece of their domestic agenda. Pelosi promised that Democrats will pass "something," yet Democratic leaders are admittedly slowing down and thinking about their options. Though President Obama urged Congress in his State of the Union address to "finish the job for the American people," he did not set a deadline for doing so.

The choice they make will likely hinge on several things, including balancing what the White House wants against what Democratic leaders think they can get, interpreting what voters in Massachusetts were saying, and divining what, if anything, the outcome means for the November midterm elections.

Clearly the Senate math has changed.

The loss of the late Sen. Ted Kennedy's seat to Republican Scott Brown leaves Democrats with 59 votes, one shy of what they need to block a filibuster. That means the old plan of merging the bills passed by the House and Senate and then sending a new bill through both chambers is dead unless the Senate tries to vote on something before Brown is seated. But President Obama, along with several Senate Democrats, quickly ruled that out.

"People in Massachusetts spoke," Obama said last week. "[Brown has] got to be part of that process."

There is serious head-scratching within the party about the message Massachusetts voters sent, and hence the appropriate response. Some say voters were upset with the administration for trying to do too much at once, for reaching too far with healthcare reform, for putting the government too far into their lives. Then there are those who say the opposite -- that the administration hasn't done enough, that change is happening too slowly, that people are upset with Congress's glacial pace.

If the latter is true, Congress should buckle down, not give up, healthcare reform advocates say. "What the Congress needs to understand is that people expect Democrats and people in government to get something done," says Richard Kirsch, national director of Health Care for America Now, the largest reform advocacy group. "Using this as an excuse not to do healthcare would be totally self-defeating."

One of the few polls on election night gives weight to Kirsch's argument. The poll, run by a handful of progressive groups, found that among people who voted for Obama in 2008 but voted for Brown on Tuesday, significantly more said they were opposed to reform because they felt it doesn't go "far enough" than because it goes "too far."

Like Obama, House and Senate Democratic aides insist that healthcare reform is not dead and say that it will move forward in some form. The task, they say, is to regroup, not to retreat. "I think what we've learned is that change is not easy," says a House Democratic aide. "Bringing about real change, sweeping change, is not a quick process. There are going to be people on both sides saying you haven't done enough or you've done too much." The challenge, the aide says, is finding the comfort zone of the American people.

But what exactly are the options? In theory, the House could pass the Senate's version of the bill, keeping the Senate from having to do anything more. But Pelosi rejected that idea last week, in part because the Senate bill is loaded with all those "unpalatable" deals Reid used to win votes in his chamber -- deals, Pelosi suggested, that may have contributed to voter backlash. A second option would be to pare the bill back, stripping it down to a core set of reforms that could win bipartisan support or have a clear impact on the federal budget, like taxes and new restrictions on insurers, which the Senate could pass with only 51 votes.

Yet that approach has problems, too. Say, for example, that lawmakers decide to keep the popular provision requiring insurers to cover pre-existing conditions but don't require individuals to sign up for insurance. That most likely would mean that more sick people than healthy people would enroll, which could cause premiums to shoot up. Democrats would then want to add in the individual mandate. But if they're forcing people to buy insurance, they'll also want to provide subsidies to help them afford it, and so forth. As Missouri Democratic Sen. Claire McCaskill put it, there are so many "interrelated" pieces that it's hard to see how the bare-bones approach would work.

That leaves one last option: trying to get at least one Republican in the Senate back on board. The obvious choice is Maine Sen. Olympia Snowe, who voted for the Senate Finance Committee's bill in October but against the final Senate bill. Winning her support, however, will require significant changes. She has major problems with Reid's "employer mandate," which would force many businesses to pay penalties if they didn't give insurance to workers. Snowe fears the mandate would hurt Maine's many small businesses. She's also concerned that the bill, as written, will force people to buy more insurance coverage than they can afford and will cause premiums to jump in the next few years, in the period before people have access to subsidies and exchanges.

President Obama hasn't given up on Snowe; he spoke with her personally in the days leading up the Massachusetts election. But even if Democrats woo Snowe or another Republican, such as fellow Maine Sen. Susan Collins, questions remain about how healthcare and the Democrats' newfound struggles will affect the November elections. Advocates say passing a bill will help vulnerable Democrats, not hurt them. "Democrats have to understand they have to produce if they are going to get re-elected," says Kirsch. But emboldened Republicans have a different read. On Wednesday, news broke that Rep. Mike Pence, an Indiana Republican, is considering running against Indiana Sen. Evan Bayh, a moderate Democrat. That probably won't be the last challenge, either.

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Healthcare Reform - Democrats Struggle to Move Forward on Healthcare | Kent Garber