Monday, November 9, 2009

Health bill faces battle in Senate

health insurance

WASHINGTON - With the struggle over health care entering another difficult phase, President Obama has hit a milestone and a speed bump in his dual pursuit of a major overhaul of the nation's medical system and a rebirth of progressivism in America.

House approval of the legislation Saturday, even if Democrats can move it no further, was an accomplishment that has eluded presidents for decades. But the close vote and the exertions it took to secure a majority were laden with warning signs as the issue moves to the Senate.

The health-care overhaul was a tough sell in the liberal-leaning House, and the bill turned out to be more conservative in its price tag, more limited in the scope of its government-run insurance option, and tighter in its restrictions on abortion funding than many Democrats had hoped.

The narrow victory - 220 to 215 in a chamber where Democrats hold 258 seats - was unsettling for liberals because moderate Democrats have a louder voice in the Senate and Republicans have more delaying power. Rep. Joseph Cao, a first-term Republican who holds an overwhelmingly Democratic seat in New Orleans, cast the only Republican vote.

And now the political climate has become more challenging for progressivism than it was when Obama's agenda for change was hatched in his 2008 presidential campaign and ratified with his election.

"The joys and the exultant expectations . . . have been mainly silenced by a year of economic turmoil and international uncertainty," Democratic pollster Peter Hart wrote in a recent memo marking Obama's election anniversary. "But more striking than the domestic and international struggles is the sense of disappointment and disgust the American public feels toward Washington."

A year ago, rising health-care costs were at the top of voters' worries; now, with unemployment in double digits, jobs are paramount. "It's an historic accomplishment, but I'm not sure it's consistent of the public mood," said Vin Weber, a Republican strategist, said of the House health-care bill.

A sign of the shift is that Obama and Democratic leaders have had to lean so hard on Democrats to take a vote many saw as fraught with political risks rather than rewards.

"Given the heated and often misleading rhetoric surrounding this legislation, I know that this was a courageous vote for many members of Congress," Obama said yesterday, "and I'm grateful to them and for the rest of their colleagues for taking us this far. "Now it falls on the United States Senate to take this baton and bring this effort over the finish line."

That line may not be crossed as soon as Democrats had hoped. It looks likely that a bill will not be ready for Obama to sign until after the New Year holiday. "It's too bad the president has to spend all this time trying to rustle up votes within his own party," said Jim Manley, spokesman for Senate Majority Leader Harry Reid (D., Nev.). "But I honestly believe the House vote gives us momentum that Senator Reid is going to use when he talks to his colleagues this week."

Reid has yet to put the finishing touches on the bill that will be the starting point of Senate debate, a blend of versions produced by two committees.

The Senate bill would have major areas of overlap with the House's: Both would expand Medicaid coverage for the needy, provide private-insurance premium subsidies for people of modest means, and set rules to make it harder for insurance companies to deny coverage or charge higher rates to people based on their medical status or history.

Both bills would require everyone to have health insurance and set up an insurance exchange to offer affordable policies for small businesses and individuals not covered by their employers. Both bills would include one government-run public option among the choices. But Reid has said that his bill would allow states to opt out of offering the government plan.

Senate Republican Leader Mitch McConnell of Kentucky yesterday noted that the 39 House Democrats who voted against the bill represented 1 in 7 Democrats in the House caucus. "Americans don't want a 2,000-page, trillion-dollar government experiment," he said.

Despite the changes made in the House bill to win enough conservative Democratic and antiabortion votes to pass, the measure is still generally regarded as too liberal for the Senate. "The House bill is dead on arrival in the Senate," Sen. Lindsey Graham (R., S.C.) said yesterday on CBS's Face the Nation.

In both the Senate and the House, centrist Democrats have tremendous leverage over their party's liberal majority. The threat of losing their votes is what drove House leaders to make concessions on the public option that liberals did not like - and to allow restrictions on abortion vigorously opposed by a majority of House Democrats.

Even though that abortion amendment was approved, its opponents still swallowed hard before voting for final passage - a show of pragmatism that probably will be required among Senate Democrats, too.

"Getting the best possible bill that doesn't pass isn't legislation," said Rep. Jim McGovern (D., Mass.).