Landmark health care legislation backed by President Barack Obama passed its sternest Senate test in the pre-dawn hours early Monday, overcoming Republican delaying tactics on a 60-40 vote that all but assures its passage by Christmas.
"Let's make history," said Sen. Tom Harkin, D-Iowa, shortly before the bill's supporters demonstrated their command of the Senate floor in an extraordinary holiday season showdown.
The bill would extend coverage to more than 30 million Americans who now lack it, while banning insurance company practices such as denial of benefits on the basis of pre-existing medical conditions.
The atmosphere was intensely partisan, but the outcome pre-ordained as senators cast their votes from their desks, a practice reserved for issues of particular importance. Administration officials who have worked intensely on the issue watched from the visitor's gallery despite the hour. So, too, Vicki Kennedy, the widow of Sen. Edward M. Kennedy, D-Mass., who championed health care across a Senate career that spanned more than 40 years.
Perhaps the Republican criticism of Sen. Ben Nelson (D-Neb.) is misplaced: Nebraska is set to reap only a fraction of the $1.2 billion in special Medicaid deals for three states.
Vermont, which is represented by the once-wavering Sen. Bernie Sanders, would recieve $600 million over 10 years for its Medicaid costs, according to Congressional Budget Office figures requested by Senate Republicans.
Massachusetts would see $500 million, according to the CBO.
Nelson, who has been lambasted throughout the day, steered only (!) $100 million to his state to cost the full cost of the Medicaid expansion.
Ben Nelson’s “Cornhusker Kickback,” as the GOP is calling it, got all the attention Saturday, but other senators lined up for deals as Majority Leader Harry Reid corralled the last few votes for a health reform package.
Nelson’s might be the most blatant – a deal carved out for a single state, a permanent exemption from the state share of Medicaid expansion for Nebraska, meaning federal taxpayers have to kick in an additional $45 million in the first decade.
But another Democratic holdout, Sen. Bernie Sanders (I-Vt.), took credit for $10 billion in new funding for community health centers, while denying it was a “sweetheart deal.” He was clearly more enthusiastic about a bill he said he couldn’t support just three days ago.
Nelson and Sen. Carl Levin (D-Mich.) carved out an exemption for non-profit insurers in their states from a hefty excise tax. Similar insurers in the other 48 states will pay the tax.
Vermont and Massachusetts were given additional Medicaid funding, another plus for Sanders and Sen. Patrick Leahy (D-Vt.) Three states – Pennsylvania, New York and Florida – all won protections for their Medicare Advantage beneficiaries at a time when the program is facing cuts nationwide.
All of this came on top of a $300 million increase for Medicaid in Louisiana, designed to win the vote of Democratic Sen. Mary Landrieu.
Under pressure from the White House to get a deal done by Christmas, Reid was unapologetic. He argued that, by definition, legislating means deal making and defended the special treatment for Nelson’s home state of Nebraska.
“You’ll find a number of states that are treated differently than other states. That’s what legislating is all about. It's compromise," he said.
It was Nelson who proved that he who plays hardest to get, gets the most.
He forced Reid to redraft the bill’s restrictions on federal funding of abortion. And while most insiders were focused on that deal, Nelson was quietly ensuring that his state would never have to pay for the Medicaid expansion being written into the bill – an agreement that had been in the works for weeks.
Medicaid is usually paid for with a mix of federal and state funding, but Nelson's carve out means that any Medicaid beneficiaries who join the program under the bill will be fully paid for by the federal government.
It's an important deal considering that many governors are worried that the Medicaid expansion will further strain already stressed state budgets – and one that came after Nebraska Gov.Dave Heineman called on Nelson to vote against the bill.
"The State of Nebraska cannot afford an unfunded mandate and uncontrolled spending of this magnitude,” the governor wrote to Nelson.
Nelson deferred all questions on the provision to Reid, saying only that he was “comfortable” the deal took care of Nebraska.
But Nelson’s deal could be a pittance compared to where the Nebraska compromise might ultimately lead – to 49 other states demanding that the feds pick up their share of health reform’s new Medicaid burden when it kicks in during 2017.
"When you look at it, I thought well, God, good, it is going to be the impetus for all the states to stay at 100 percent [federal funding]. So he might have done all of us a favor," Sen. Tom Harkin (D-Iowa) said of Nelson’s dealings.
Nelson and Levin also pushed a provision that exempts non-profit insurers in Nebraska and Michigan from an annual multi-billion dollar excise tax on insurance companies.
Not surprisingly, both states are home to non-profit insurers who control a high-percentage of the industry’s profits. In Michigan, non-profit insurers control 76 percent of the industry’s profits – one of the highest percentages in the nation – while Nebraska non-profits control 46 percent of their state’s profits.
And in an example of how closely senators guarded details, Levin’s office did not answer any questions about the proposal when asked about it on Friday.
Republicans, meanwhile, expressed outrage at the wheeling and dealing, as if their party had never cut a legislative deal in its 150-year history.
“This bill is a monstrosity, a 2,100-page monstrosity full of special deals for people who are willing to vote for it,” said Senate Republican Leader Mitch McConnell. “And they’re playing these kind of games with the nation’s health care. This is an outrage.”
But Sanders didn’t sound outraged when he talked about the extra Medicaid funding Vermont will get for six years. Massachusetts, meanwhile, received three years worth of additional Medicaid funding. Under the original bill, neither state had qualified for the money.
Republican Sen. Mike Enzi accused Democratic leaders of favoring Medicare Advantage beneficiaries in Pennsylvania, New York and Florida at the expense of seniors in other parts of the country.
“The Democrats are playing ‘Let’s make a deal’ with trillions of your hard-earned tax dollars. You and all the American people should know that the majority leader is buying his votes with your money,” said Enzi (R-Wyo.) “The Reid bill gives sweetheart deals to a few states and the rest of the country will foot the bill. Making unfair deals like this is the wrong way to legislate and the American people know it.”
And while there were plenty of state-specific deals, some of the changes were clearly aimed at pleasing specific Democratic factions. For instance, tightened insurance regulations went a long way toward putting a smile on the faces of liberal senators who have lost their much-loved public option.
The amendment mandates that insurers spend no less than 80 percent of their premium revenues providing medical care. Currently, insurers spend about 70 percent of their premiums paying for health care. The bill also eliminates insurers’ ability to cap annual coverage amounts.
In brief remarks at the White House, President Barack Obama also highlighted some new provisions, including penalties for insurers who “arbitrarily jack up rates” and an immediate prohibition on insures’ ability to deny children coverage.
Obama, too, talked of the deals as just the cost of doing business in Washington.
“As with any legislation, compromise is part of the process,” Obama said. “But I'm pleased that recently added amendments have made this landmark bill even stronger.”
A $626 billion Pentagon budget narrowly advanced in the Senate Friday morning, but not before Washington’s political battles seemed to eclipse the real wars of Iraq and Afghanistan.
The Senate scene, played out in a post-midnight session on a freezing night, dramatized how poisonous the atmosphere has become in the health care fight.
Defense Secretary Robert Gates had to weigh in for fear the military would be left with only stop-gap funding while fighting two wars overseas. And ailing 92-year-old Sen. Robert Byrd (D-W.V.) was wheeled in for the 1 a.m. vote while his old friend Sen. Thad Cochran (R-Miss.) deserted the bill under pressure from his own leadership to slow action.
Senate Minority Leader Mitch McConnell (R-Ky.) made no secret of the fact that he was looking for leverage over Majority Leader Harry Reid (D-Nev.) to delay action on health care reform until after Christmas. The pressure on rank-and-file members was severe, and it was only after Democrats had secured the needed 60 votes that three Republicans broke ranks in support of cutting off debate.
“Not even the darkness outside can conceal the games being played inside this Senate chamber,” Reid said in closing remarks before the vote. “We are here in the middle of the night, but the reason is as clear as day.”
By contrast, the same defense measure — including $128 billion for operations in Iraq and Afghanistan — sailed through the Houseon Wednesday on a 395-34 vote. Cochran, the ranking Republican on the Senate Appropriations Committee, had worked closely with Chairman Daniel Inouye (D-Hawaii) to ensure passage. And toward this end, Democrats pared back extraneous provisions and devoted the bulk of the additional domestic spending to jobless benefits for the long-term unemployed.
“It is a good bill. It ought to be passed, and it ought to be passed as soon as possible,” Cochran said on the floor Wednesday. But after a health care blowup on the floor that day infuriated McConnell, Cochran was pressed by his leadership to slow progress at least until Reid comes forward with the text of proposed changes being made in the Democrats' health care package.
In a statement after the vote, the Mississippian said his party felt it was important to act in “unison,” but that he was confident the measure would soon pass. “I regret that its consideration is being affected by the divisive end-of-session debate on health care reform.”
Neither party is blameless in the sorry state of the defense budget, which should finally clear Congress on Saturday, almost three months into the fiscal year that began Oct. 1.
Democrats stalled action themselves for months, hoping to use it as the locomotive for an end-of-the-year train of legislative items. “The Republicans didn’t control the timing on this bill,” said Minority Whip Jon Kyl (R-Ariz.). “Why haven’t the Democrats been able to bring this most important bill to the Senate for a vote until a week before Christmas?”
Nonetheless the bare-knuckle Republican tactics are most striking because GOP members are typically very supportive of defense spending and reluctant to do anything to obstruct the annual Pentagon budget.
That tradition is wearing thin in today’s Washington. The 1 a.m. vote in the Senate echoed a fight last summer in the House during which Republicans opposed new war funding because they were upset that money for the International Monetary Fund had been added to the package.
“I think they picked the wrong bill for it,” said Senate Majority Whip Richard Durbin (D-Ill.). “Why are we putting the men and women in uniform in the middle of this debate? They didn’t ask for that.”
The three Republicans who supported cloture were Sen. Kay Bailey Hutchison of Texas and Maine Sens. Olympia Snowe and Susan Collins — all representing states with a major economic stake in the defense budget.
Despite a last-minute weekend deal that put the Senate on the brink of passing health care reform this week, liberal and moderate Democrats remain on a collision course over the bill, as both sides dug in Sunday for the next phase of negotiations.
President Barack Obama’s liberal base and powerful union leaders once hoped the expected House-Senate conference would partly undo a year of retreats and compromises, with Obama weighing in to nudge the moderate Senate bill to the left.
But the titanic struggle to lock in Sen. Ben Nelson (D-Neb.) as the 60th senator for the first key test vote early Monday morning has changed all that. The need to hold Nelson and other moderates in line means major changes on the public option, abortion, taxes, Medicare and Medicaid are unlikely — and that the Senate’s vision of health reform is likely to prevail over the House’s in the final talks.
“It is very clear that the bill — the final bill — to pass in the United States Senate is going to have to be very close to the bill that has been negotiated here,” Sen. Kent Conrad (D-N.D.) said on “Fox News Sunday.” “Otherwise, you will not get 60 votes in the United States Senate.”
Nelson, who received assurances of a “limited conference” to secure his vote for the Senate bill, has already laid down at least two deal breakers in the House bill that he can’t support: the inclusion of a government insurance plan and an income tax increase on wealthy individuals.
“That would break it,” Nelson said on CNN’s “State of the Union.”
House Democrats acknowledge that they will be limited in how far they can tweak the Senate compromise. But House leadership also knows that its rank and file need to force some changes, however small, before they will accept the final package — as a face-saving measure to be able to swallow late changes to the bill in the Senate, most notably the decision to eliminate a public option.
But on the left, the sentiments of a liberal base that revolted over concessions to moderates were channeled Sunday by Howard Dean, the former Democratic National Committee chairman, who last week repeatedly called on Democrats to scrap the bill.
“This can’t be the final version of the bill,” Dean said on NBC’s “Meet the Press.” “It simply sets us on a track in this country which is expensive and where we’re going to have lots more political fights.”
In a slight shift, however, Dean tempered his words, saying the bill is better than it was earlier in the week.
“I would certainly not vote for this bill if this were the final product,” Dean said. “I would let this thing go to conference committee, and let’s see if we can fix it some more.”
Andy Stern, president of the Service Employees International Union, identified areas beyond the public option in which Democrats in both chambers could agree, including boosting the federal insurance subsidies for middle-income Americans and strengthening insurance regulations.
“It is about progress, and we now have to fight for the changes in the conference committee and decide, when it is over,” whether to support it, Stern said on CNN’s “State of the Union.”
Senior administration officials contend the conference will not be as difficult as predicted because the differences between the two chambers have been known for months. “Once the Senate passes this bill, obviously there’s work to be done,” White House senior adviser David Axelrod said on “State of the Union.”
Two big voices in the health-reform debate came out with endorsements of the measure moving ahead in the Senate this week: the Federation of American Hospitals, which represents private community hospitals, and AARP, the nation’s largest seniors organization, which urged the Senate to move ahead with debate.
In addition, Democrats desperately tried to avoid an ugly public fight over abortion, but it looks as though the issue will haunt them right up until the end.
Abortion-rights supporters and foes alike blasted the compromise Senate Majority Leader Harry Reid (D-Nev.) cut with Nelson late Friday night. But it’s unclear whether their opposition will be enough to sink the broader bill.
“I have some deep reservations with this Nelson language on first examination,” Rep. Diana DeGette (D-Colo.), a co-chairwoman of the Congressional Pro-Choice Caucus, told POLITICO on Sunday.
Rep. Bart Stupak (D-Mich.), a leading abortion opponent, said during the weekend, “While I and many other pro-life Democratic House members wish to see health care coverage for all Americans, the proposed Senate language is unacceptable.”
The final Senate bill grants state legislatures the right to prevent insurance plans that operate in the proposed health insurance exchange from covering elective abortions. The changes also require people who seek abortion coverage through the exchange to pay two separate checks each month to their insurance company to “segregate” federal funds from private funds that pay for abortion.
Reproductive-rights advocates argue the new system would create a more onerous burden for women seeking coverage for the procedure, while abortion opponents have argued throughout the debate that segregating payments still violates the existing prohibition on federal funds being used to pay for abortion.
Douglas Johnson, the legislative director of the National Right to Life Committee, called the changes “book-keeping contortions” and said that his group plans to put pressure on any senator who votes to consider the changes Reid unveiled.
But the real fight will occur in negotiations between House and Senate leaders over a final bill.
House Speaker Nancy Pelosi of California can’t afford to lose any Democrats. And with Stupak threatening to vote against the Senate compromise, she’ll need to offset his vote with other Democrats who voted against it the first time. She might be able to pick up some moderate-to-conservative Democrats who favor the Senate approach, but many of these lawmakers will need to be OK with the final abortion restrictions.
On the other side, a bloc of abortion-rights backers, led by DeGette, has already promised to vote against any bill that includes Stupak’s amendment, which would prevent people who receive government subsidies from purchasing coverage for elective abortions through the exchange. DeGette believes many of the 41 Democrats who voted for Stupak and “yes” on the House health care bill are willing to work with party leaders to find a middle ground.
The opposing camps are similarly entrenched on the public option and the method for financing the health care expansion. The House would create a government-sponsored insurance plan, but the Senate bill is silent on this point. After several attempts at compromise, Reid nixed the public option altogether.
The taxes could prove difficult to bridge. The House relies on a so-called millionaires’ tax, and has refused to consider the tax on expensive insurance plans. The Senate has taken the exact opposite posture. But because the White House has weighed in several times in favor of the tax on “Cadillac” plans, as a key component to slow the growth rate in health care spending, the Senate is likely to win this round.
Meanwhile, Republicans increaed their attacks on the bill Sunday, criticizing a variety of deals cut to win the votes of Democratic senators, such as Nelson, who got the federal government to pick up the cost of any Medicaid expansion under the health reform bill in the state of Nebraska forever. Republicans said Democrats have refused to say which state would get about $100 million inserted into the bill on behalf of a still unidentified university hospital.
“This process is not legislation. This process is corruption,” said Sen. Tom Coburn (R-Okla.). “And it’s a shame that that’s the only way we can come to consensus in this country is to buy votes.”
But Nelson defended his efforts. “I always put Nebraska first,” he told POLITICO in an interview Saturday. “But I looked at this through the standpoint of Nebraskans and the country. ... There is a difference between holding out for something and holding up. I was holding out for something to make it better.”
Unless some Legislator pulls off a last-minute double-cross, Health Care Reform will pass the Senate this week. Count me among those who consider this an awesome achievement.
It’s a seriously flawed bill, we’ll spend years if not decades fixing it, but it’s nonetheless a huge step forward.
It was, however, a close-run thing. And the fact that it was such a close thing shows that the Senate — and, therefore, the U.S. government as a whole — has become ominously dysfunctional.
After all, Democrats won big last year, running on a platform that put health reform front and center. In any other advanced democracy this would have given them the mandate and the ability to make major changes.
But the need for 60 votes to cut off Senate debate and end a Filibuster — a requirement that appears nowhere in the Constitution, but is simply a self-imposed rule — turned what should have been a straightforward piece of legislating into a nail-biter. And it gave a handful of wavering senators extraordinary power to shape the bill.
Now consider what lies ahead. We need fundamental financial reform. We need to deal with climate change. We need to deal with our long-run budget deficit. What are the chances that we can do all that — or, I’m tempted to say, any of it — if doing anything requires 60 votes in a deeply polarized Senate?
Some people will say that it has always been this way, and that we’ve managed so far. But it wasn’t always like this. Yes, there were filibusters in the past — most notably by segregationists trying to block civil rights legislation. But the modern system, in which the minority party uses the threat of a filibuster to block every bill it doesn’t like, is a recent creation.
The political scientist Barbara Sinclair has done the math. In the 1960s, she finds, “extended-debate-related problems” — threatened or actual filibusters — affected only 8 percent of major legislation. By the 1980s, that had risen to 27 percent. But after Democrats retook control of Congress in 2006 and Republicans found themselves in the minority, it soared to 70 percent.
Some conservatives argue that the Senate’s rules didn’t stop former President George W. Bush from getting things done. But this is misleading, on two levels.
First, Bush-era Democrats weren’t nearly as determined to frustrate the majority party, at any cost, as Obama-era Republicans. Certainly, Democrats never did anything like what Republicans did last week: G.O.P. senators held up spending for the Defense Department — which was on the verge of running out of money — in an attempt to delay action on health care.
More important, however, Mr. Bush was a buy-now-pay-later president. He pushed through big tax cuts, but never tried to pass spending cuts to make up for the revenue loss. He rushed the nation into war, but never asked Congress to pay for it. He added an expensive drug benefit to Medicare, but left it completely unfunded. Yes, he had legislative victories; but he didn’t show that Congress can make hard choices and act responsibly, because he never asked it to.
So now that hard choices must be made, how can we reform the Senate to make such choices possible?
Back in the mid-1990s two senators — Tom Harkin and, believe it or not, Joe Lieberman — introduced a bill to reform Senate procedures. (Management wants me to make it clear that in my last column I wasn’t endorsing inappropriate threats against Mr. Lieberman.) Sixty votes would still be needed to end a filibuster at the beginning of debate, but if that vote failed, another vote could be held a couple of days later requiring only 57 senators, then another, and eventually a simple majority could end debate. Mr. Harkin says that he’s considering reintroducing that proposal, and he should.
But if such legislation is itself blocked by a filibuster — which it almost surely would be — reformers should turn to other options. Remember, the Constitution sets up the Senate as a body with majority — not supermajority — rule.
So the rule of 60 can be changed. A Congressional Research Service report from 2005, when a Republican majority was threatening to abolish the filibuster so it could push through Bush judicial nominees, suggests several ways this could happen — for example, through a majority vote changing Senate rules on the first day of a new session.
Nobody should meddle lightly with long-established Parliamentary procedure. But our current situation is unprecedented: America is caught between severe problems that must be addressed and a minority party determined to block action on every front. Doing nothing is not an option — not unless you want the nation to sit motionless, with an effectively paralyzed government, waiting for financial, environmental and fiscal crises to strike.
Everyone hated Harry Reid, but Matthew Yglesias says today he proved himself a hero by squeezing 60 votes from a cranky, uncooperative Senate for historic health-care legislation.
There are some politicians who are more hated than Senate Majority Leader Harry Reid, but few are less loved. The national numbers recorded on Polling Report are dismal. A recent Research 2000 poll has him at a 32/53 favorable/unfavorable split. An October NBC/Wall Street Journal poll showed that just 2 percent of the public had “very positive” feelings toward Reid.
To the right, he’s the menacing, uncharismatic face of American liberalism, paired with Nancy Pelosi as the real architect of the Democratic legislative agenda in order to bypass Barack Obama’s still-considerable personal popularity. But to the left, he’s the face of repeated sellouts, of ineffectuality, of corrupt bargains and unsatisfactory compromises. Even the people of his home state of Nevada hate him. He’s losing in the polls against both possible Republican opponents, and his 38/49 favorable/unfavorable rating is disastrous for an incumbent.
His unpopularity at home, however, only underscores the real truth about Reid—his performance throughout 2009 has been nothing short of heroic. Faced with epic political problems at home and major national challenges in Washington, he’s done what all too few senators do: Put his personal concerns aside and thrown his time and energy into said challenges.
And daunting as those are, the intellectual and policy problems involved are minor compared to the political and logistical problems involved with leading the modern Senate. The anger and disappointment liberals direct toward Reid, in particular, is almost entirely misguided and would be better channeled into support for reforming the world’s most dysfunctional legislative body.
In a normal legislature, you need 50 votes to pass a health-care bill. Reid needed to bargain with Susan Collins and Olympia Snowe, and moderate Democrats from a position of strength. With 60 senators now in favor of the legislation, a bill will almost certainly pass. The question now is what it looks like, and people looking for concessions need to bargain against each other for the privilege of being catered to.
Instead, Reid dealt with a combination of sky-high expectations from the base and the recently created world of the 60-vote Senate. In that chamber, he needed the vote of each and every Democrat—from wild card Roland Burris to independents like self-described “socialist” Bernie Sanders, to McCain-endorsing Joe Lieberman. Not only was it difficult to round up 60 votes; it was especially difficult to round up 60 out of 60. When each and every individual member knew that he or she could hold the whole thing hostage to an idiosyncratic concern, the incentives to do so were enormous.
But despite the challenges, Reid looks about to deliver on a comprehensive overhaul of the American health-care system.
It’s a titanic legislative achievement, and if it happens it would happen under unprecedented circumstances. The emergence of supermajority rule in the Senate, after all, makes for a bad match with a different new trend, the post-1994 conventional wisdom that the best road back to political power for a minority is to deal “defeats” to the majority.
Republicans used that logic 15 years ago to defeat Bill Clinton’s plans for health-care reform, and Democrats employed it in 2005 and held firm against George W. Bush’s plans to privatize Social Security. There’s nothing wrong, in general, with the idea of a minority party offering blanket opposition to the other party’s agenda. That, after all, is how legislating works in most countries. But in most countries, the majority gets to do what it wants.
The contemporary United States, however, has been engaged recently in an experiment in what happens if you give the minority the power to block bills, and reward the minority politically for succeeding in doing so. The results aren’t pretty, and the system needs to be reformed.
But health care can’t wait for that to happen. So instead, circumstances left Reid with the nearly impossible mission of holding together a unanimous caucus. And he had to do so with few weapons of formal discipline at his disposal. On the Republican side, committee chairmen are term-limited and will soon enough need to secure support from their colleagues for a new post. That gave them an incentive to stay cooperative and well-liked. Democrats hand these offices out on the basis of pure seniority, depriving the leadership of an important source of glue and cohesiveness.
One’s instincts are that overcoming these challenges required some kind of larger-than-life figure, full of colorful LBJ-style anecdotes, or maybe a figure of overwhelming charisma and popularity. That’s not Harry Reid. But the proof is in the pudding, and from where we sit today the low-key, unassuming, unpopular Senator from Nevada has delivered on the most significant piece of progressive legislation in over 40 years. That ought to be worth the approval of more than 32 percent of the public.
Sen. Ben Nelson intends to support health care legislation backed by President Barack Obama, giving the measure a 60th and decisive vote, Democratic officials said.
These officials say the Nebraska Democrat will make an announcement later Saturday. Marathon negotiations with the White House and Senate Democratic leaders produced fresh concessions that will mean additional abortion restrictions in the legislation.
The officials spoke on condition of anonymity because Nelson hadn't announced his decision.
Word of Nelson's decision came as Democratic leader Harry Reid of Nevada unveiled a final series of revisions to the health care bill, and Republicans dug in to prevent its passage for as long as possible.
In earlier developments, Obama warned Saturday the country's powerful insurance industry was determined to thwart a dramatic improvement in patients' rights as it lobbies against his signature healthcare reforms.
"They want to preserve a system that works better for the insurance industry than it does for the American people,'' Obama said in his weekly Internet and radio address.
Obama has asked the Senate to finish by year's-end to prevent the issue from spilling into the campaign for November 2010 congressional elections. Opinion polls show the bill losing public support, with majorities now opposed to it.
The healthcare bills would significantly expand coverage for currently uninsured Americans, and would also prevent insurance companies from denying coverage to people on the basis of pre-existing health conditions.
Opponents of reform say it will drive up the costs of coverage for many Americans and represents an unwelcome government intrusion into the private sector.
Obama said that healthcare reform would cut costs and shield patients from corporate abuse.
"The protections currently included in both the health insurance reform bill passed by the House and the version currently on the Senate floor would represent the toughest measures we've ever taken to hold the insurance industry accountable,'' Obama said.
"The insurance industry knows all this. That's why they're at it again, using their muscle in Washington to try to block a vote they know they will lose,'' he said.
With the clock ticking down on health care reform, Senate Majority Leader Harry Reid (D-Nev.) has until Saturday to strike a 60-vote compromise if Democrats hope to meet a Christmas Eve deadline - but the obstacles kept piling up Thursday.
Reid still had no legislative text and no cost analysis to release. One of the final moderate holdouts, Sen. Ben Nelson (D-Neb.), rejected compromise language on abortion funding and said he's doubtful a bill can pass by Christmas. Two powerful unions blasted the bill. House Democrats threatened to undo the Senate bill during a conference committee. And a Democratic war over the bill raged on the Internet and cable news.
The White House sunk deeper into the fight within its own party, working throughout the day to discredit the claims of former Democratic National Committee Chairman Howard Dean that the Senate bill is so weak it should be scrapped.
The net effect was the loss of any sense of inevitability surrounding the passage of health care legislation by the end of the year as Reid struggled to keep it on track.
"If we are going to get a bill out of the Senate, which will be very close to getting a bill enacted, we have to do it in 2009," said Sen. Bob Casey (D-Pa.), who is working on the abortion compromise with Nelson. "Some might not think so, but what I would worry about is losing momentum."
"We're down to 48 to 72 hours," he said at 2 p.m. Thursday.
Reid needs a commitment - privately or publicly - from Nelson and other undecided senators by Saturday night, which is the drop-dead time at which the majority leader must begin the procedural steps necessary to finish the bill by Christmas Eve. The current timeline would have the Senate taking a series of votes: at 1 a.m. Monday, 7 a.m. Tuesday, 1 p.m. Wednesday and 7 p.m. Christmas Eve.
If the Senate fails to break a Republican filibuster early Friday morning on a Department of Defense appropriations bill, the timeline will be set back by a day, potentially pushing the vote to Christmas Day.
But even this schedule depends largely on Nelson, who remains the biggest concern by far for the White House and the Senate Democratic leadership. He has given no indication of which way he will go.
"I don't have a timetable to do that," Nelson told POLITICO of his decision. "We're still working on language, and a number of issues are under consideration right now that I've requested. And we'll have all that information back and see the [Congressional Budget Office] numbers on the package that was sent over a week ago. Then we'll look at everything, and I'll make my decision."
Nelson rejected a compromise from Casey as insufficient in terms of preventing public money from being used on abortions. This was a significant blow to Reid's effort to line up 60 votes because Nelson has said he would filibuster the bill unless the abortion language mirrored what was included in the House bill.
Nelson said his concern with the compromise language was that policyholders would be required to "opt-out" of abortion coverage, and their premiums would subsequently be reduced. By contrast, the language in the House bill requires people to proactively seek abortion coverage, Nelson said.
One reason why Reid continues to wrangle with the Congressional Budget Office over the cost estimate is that he is trying to find ways to accommodate Nelson, according to an official familiar with the negotiations.
Reid spokesman Jim Manley said the majority leader is "not unduly alarmed" by Nelson's concerns with the bill and is "still working to address" them.
At the same time, Democrats worked to protect their left flank. In a reversal of fortune for Obama, progressives attacked the plan moving through the Senate as "hollow," "unsupportable" and a sellout to corporate interests.
The theory has always been that as long as Democrats kept the moderates happy, liberals wouldn't thwart a deal in the end. But for the first time in this lengthy debate, it looked like some of them might. Sen. Bernie Sanders (I-Vt.), who favors a government-financed health care system, remains uncommitted on the bill.
The disagreement broke into the light of day Thursday when senior White House adviser David Axelrod slammed Dean, who argued in a Washington Post op-ed that the bill meets none of his benchmarks for "real reform."
"As it stands, this bill would do more harm than good to the future of America," Dean wrote, then took to the airwaves to amplify his case.
Axelrod called in to MSNBC's "Morning Joe" to argue that Dean's criticisms are "predicated on a bunch of erroneous conclusions."
"To defeat a bill that will bend the curve on this inexorable rise in health care costs is insane," Axelrod said. "I think that would be a tragic, tragic outcome. I don't think that you want this moment to pass. It will not come back."
Both the AFL-CIO and the Service Employees International Union released statements Thursday condemning the Senate bill - but stopped short of explicitly opposing it.
While the liberal revolt flared outside the Capitol, progressives in the Senate were showing no sign Thursday of peeling away.
Sen. Debbie Stabenow (D-Mich.), who supported the public option, said she had has "no hesitation voting for this - and I am someone who would vote for a single-payer system."
The one bright spot Thursday for Democrats may have been Sen. Roland Burris (D-Ill.), who backed away from threats to block the health care bill because it lacks a public option.
"We'll see what it is, but what the situation is now is the realization that we can't kill the bill," Burris told POLITICO. "That's the realization."
A House Democrat from Connecticut said Tuesday that Sen. Joe Lieberman should be recalled from office over his opposition to the Senate health care bill.
"No individual should hold health care hostage, including Joe Lieberman, and I'll say it flat out, I think he ought to be recalled," Rep. Rosa DeLauro (D-Conn.) told POLITICO.
Connecticut has no recall law for state officials, and the Constitution does not authorize states to recall members of Congress since each house has the authority to police its own members.
But DeLauro’s comments speak to concerns running through Democratic circles in Connecticut and in Washington after Lieberman exerted his will on Democratic leaders and the White House, saying he would join a GOP filibuster if the bill included either a public insurance option or a provision allowing people aged 55-64 to buy into Medicare.
Now it appears that the leaders will drop those plans to win the support of Lieberman and the rest of the Democratic caucus.
“There’s huge concern that borders on frustration,” Rep. John Larson (D-Conn.) said of Lieberman’s position.
“It goes beyond frustration in Connecticut in terms of the way people feel,” Larson said. “I have a great deal of respect and I have long admired Joe Lieberman. This goes against the grain of most of what he’s fought for and stood for all of his life. It’s thoroughly frustrating and disappointing for so many of us.”
Lieberman spokesman Marshall Wittmann denied that the senator was trying to block health care legislation.
“The truth is that Sen. Lieberman is seeking to pass a health care bill as soon as possible that will provide coverage to millions of Americans who lack health insurance.”
Lieberman told reporters Tuesday that he’s been working to get a bill through the Senate that enjoys majority support in the public.
In a statement, Lieberman denied flip-flopping on the Medicare buy-in proposal, saying that his support for the plan during his campaign for vice president in 2000 came at a time when the national debt was less than half what it is now – and when Medicare was not on the cusp of going broke and when there was no “viable” proposal like the one being considered on the floor.
He said comments he made to the Connecticut Post in September endorsing the idea were “before we had a bill for consideration on the Senate floor that contains extensive health insurance reforms, including limiting how much more insurance companies could charge individuals based on age and providing subsidies that would specifically help people between the ages of 55 and 65 to afford health insurance.”
He added: “I look forward to passing a bill that will give the American people genuine health care reform without impeding our recovery from the current recession or adding to our exploding national debt.”
Sen. Kent Conrad of North Dakota, a Democratic centrist, said Lieberman has actually made it easier to reach a deal on the health care bill.
"In a curious way, it may make it more possible to get something done," Conrad said of Lieberman’s position. "Because he wasn't the only one with these concerns, it's very clear - he vocalized concerns many were having."
Lieberman's home-state colleague, Democratic Sen. Chris Dodd, said the frustration arose mostly out of support for the public option back in Connecticut.
Asked about the anger directed at Lieberman, Dodd said: "It's just people's frustration for getting a bill done and strong support for a public option."
Sen. Joe Lieberman (I-Conn.) said Tuesday afternoon he thinks he's ready to vote for the Senate health care reform bill — and that his positions on the Medicare buy-in do not contradict his previously stated stances on the issue.
Coming off Monday’s caucus meeting where Democrats backed away from the Medicare buy-in and the public option, Lieberman talked of his willingness to vote for reform.
"To be as explicit as I can be now, if as it appears to be happening, the so-called public option, government-run insurance program is out, and the Medicare buy-in—which I thought would jeopardize Medicare, cost taxpayers billions of dollars over the long haul, increase our deficit—is out, and there's no other attempts to bring things like that in, then... I am getting to that position to where I can say what I wanted to say all along, that I'm ready to vote for health care reform."
Lieberman was adamant that he had not flip-flopped on the issue, despite his support of a Medicare-buy-in-like proposal in 2000 as a vice presidential candidate and then again in an interview a few months ago in the Connecticut Post. He said the current economic situation cannot be ignored in crafting what he believes to be the best bill possible.
In 2000, “the party platform was to suggest one way to reform health care was to allow 55 to 65 year-olds to buy into Medicare. That's a very stressed age group when you don't have insurance. But a lot of things have changed in nine years,” he said. The U.S. government was running a surplus, not a deficit, and Medicare wasn't on the verge of imminent bankruptcy.
"In the Connecticut Post interview—I finally got to see that on TV last night—it looked to me as if I was referring to things I had supported in the past to make the point that though I was against the public option, I was not against health care reform. And of course I did that before the Finance Committee Bill came out very large and again, I'd say generous."
Lieberman, who appeared with ranking Homeland Security Republican Susan Collins of Maine to speak about the Ft. Hood shootings, was not the only one who faced questions as a perceived on-the-fence voter for health care reform. But Collins, a moderate, said that even with the removal of the public option and the Medicare buy-in she could not see herself voting for the Senate bill as it is now.
Sen. Joe Lieberman told Senate Majority Leader Harry Reid Sunday that he couldn’t support a new Medicare proposal floated as a compromise to the public option, a development that complicates the bill’s path towards passage before the end of the year.
In a meeting in Reid’s office just off the Senate floor, aides said the Connecticut independent reiterated his concerns with the public insurance option and told the Nevada Democrat that he couldn’t support a new plan to allow people as young as 55 to buy into Medicare.
“On Friday, Sen. Lieberman told Sen. Reid that he had problems with the Medicare buy-in proposal,” said Marshall Wittmann, a spokesman for Lieberman. “Sen. Lieberman affirmed that position with Sen. Reid today.”
A Democratic leadership aide confirmed Lieberman’s comments in the face-to-face meeting, which was first reported by the Huffington Post.
Lieberman’s opposition means that Reid may once again be short of the 60 votes needed to break a filibuster if the majority leader moves forward with a health care bill that includes a Medicare buy-in proposal, whose costs are currently being analyzed by the Congressional Budget Office. Both Lieberman and fellow centrist Sen. Ben Nelson (D-Neb.) laid out their concerns Sunday with the Medicare buy-in plan on CBS’ “Face the Nation.”
“On part of it - the so-called Medicare buy-in - the opposition to it has been growing as the week has gone on," Lieberman said. "Though I don't know exactly what's in it, from what I hear I certainly would have a hard time voting for it because it has some of the same infirmities that the public option did.”
Nelson worried that the plan was a “forerunner of single payer,” a label that Sen. Jay Rockefeller (D-W.Va.) strongly rejected.
The opposition from Lieberman and the concerns of centrists adds a new wrinkle to efforts by Reid to strike a compromise – since all 40 Republicans are expected to vote to sustain a filibuster. Reid will need the support of Lieberman, Independent Sen. Bernie Sanders (Vt.) and 58 Democrats to advance the measure.
If he kills a public option or the Medicare buy-in plan, he could lose the support of Sanders and several of the more liberal members of the Democratic conference. But keeping either of those plans, or one that would “trigger” a public option if private insurers don’t hold down costs, would lose Lieberman - forcing Reid to find at least one moderate GOP senator to advance the proposal.
To win the most likely potential GOP defector, Sen. Olympia Snowe (R-Maine), Reid would likely have to make modifications and slow the debate down since she’s signaled that the Senate needs to take more time to deal with the expansive issue.
Obama to rally Democrats amid health fight. President Barack Obama will travel to Capitol Hill on Sunday to urge Senate Democrats to remain unified and pass a bill by Christmas. NBC’s Mike Viquiera reports.
President Barack Obama will meet Sunday with Senate Democrats on Capitol Hill, as a group of moderate and liberal senators weighed a new public option compromise in hopes of striking a deal by early in the week.
The president’s visit comes at the start of what will be a critical week for the health care reform bill. Senate Majority Leader Harry Reid (D-Nev.) will attempt to reach a so-far elusive compromise on the public option, and begin taking the procedural steps needed to pass a bill by Christmas.
As the Senate convened a rare Saturday session, about a dozen Democratic senators continued intensive talks on the public option, with the goal of agreeing on a framework that can garner 60 votes.
There appeared to be serious consideration of a new proposal on the table: a national health plan similar to the Federal Employee Health Benefits Plan, which provides insurance to members of Congress and federal workers. It would be administered by the Office of Personnel Management, which oversees the federal plan, and all of the insurance options would be not-for-profit.
“So in other words, what we got is a national plan that the progressives would like, but that’s where that middle is, we’re trying to find that middle,” said Sen. Tom Harkin (D-Iowa).
“There’s sort of a kind of a general agreement on where we’re headed on this thing,” Harkin added.
Sen. Blanche Lincoln (D-Ark.), a public option opponent who faces a tough reelection next year, said she was encouraged by the proposal.
“It’s one of the things that’s been talked about, and I think it bodes well for being able to do what we want to do, which is to create greater choice and options in the marketplace but also have a downward pressure on premiums on cost ,” Lincoln said. “Those are the dual objectives we've got.”
For what was expected to be a quiet weekend session, Saturday turned into a significant day for senators seeking a compromise on the public option. Moderate and liberal Democrats huddled in the morning, met separately in the afternoon, reconvened around 4 p.m., and left for the evening agreeing to resume talks Sunday afternoon. Senators said they expected to negotiate into the night Sunday.
“We’ll work until midnight or whatever it takes,” said Sen. Jay Rockefeller (D-W.V.).
The flurry of activity suggests Democrats have reached a new stage in their bid to pass a health care bill. Reid needs to develop some sort of consensus in the next few days if he hopes to pull together a “manager’s amendment” – the vehicle through which changes will be made to the bill – by the end of the weekend.
Obama’s trip to the Hill Sunday is intended to rally the caucus, and remind senators of “all the things where they have agreement,” a senior administration official said Saturday, declining to elaborate on whether he will state preferences on policy during the meeting.
Sen. Sherrod Brown (D-Ohio), who has been publicly urging the president to get more involved, said earlier on Saturday that Obama should make a strong pitch for the current Senate bill.
"I’d like to hear him push what we’re doing," he said. "I like the bill now the way it is, the president pushing the people who are more reluctant to vote for it, to vote for it."
It’s unclear whether this latest round of public-option talks will produce a result that has remained out of reach. But for the first time in months, Democrats representing every faction of the caucus were sitting at the same table.
The moderate Democrats –Lincoln, Mark Pryor (Ark.), Ben Nelson (Neb.), Thomas Carper (Del.) and Mary Landrieu (La.) – attended each session. Harkin, Rockefeller, Brown and Sen. Russ Feingold (D-Wisc.) represented the liberals. Sen. Chuck Schumer (N.Y.), another participant, has served as an intermediary between the two sides.
The Senate leadership is still eyeing Sen. Olympia Snowe (R-Maine), who has maintained regular contact with moderate Democrats in recent weeks. She participated in a separate meeting Saturday of moderates.
“We are going to either find the vertex of where everybody comes together or we are not,” Lincoln said. “It is difficult thing. We are looking for those 60.”
She said she was hopeful, adding “People really want it bad enough.”
Details on the latest proposal for the public option were limited late Saturday. Brown described it as a take-off of the Federal Employee Health Benefits Plan. With the Office of Personnel Management as the administrator, the program would be separate from the Department of Health and Human Services, which regulates the insurance marketplace.
“It would be a national, not-for-profit,” Brown said. “(The Office of Personnel Management) would administer it. It would be any number of national not-for-profits that would compete nationally and they would take the place – more conservative members hope – of the public option. They would be in states and be running a kind of lookalike to a public option.”
The nonprofit insurance companies would “go to OPM and say I want to compete and then you show them you’ve got standing to compete,” Brown said.
Existing insurance companies could participate as long as their plan is not-for-profit, he said.
Lincoln said she, as well as Snowe and Majority Whip Dick Durbin (D-Ill.), has advocated a similar proposal in the past for small businesses. The Office of Personnel Management has been effective in negotiating affordable premiums and generous benefits in the Federal Employee Health Benefits Plan – and could presumably do the same under this expanded program, Lincoln said.
“I just think it's a good idea,” Lincoln said. “I've always thought it was a good idea for quite some time now, for years, because it does utilize what we utilize as federal employees, which is volume and a good negotiator with private industry.”
Brown, however, said he is not a convert to the latest proposal. Supporters of the public option have already compromised enough, he said.
"Well, I don't think much of it, frankly, compared to a public option,” Brown said. “I'm willing to talk to anybody about anything but they haven't sold it yet."
Republicans used the weekend session to highlight nearly $400 billion in Medicare cuts to help pay for the bill, forcing Democrats to take politically-difficult votes in favor of spending cuts to the popular program for the elderly.
The Senate rejected an amendment from Sen. Mike Johanns (R-Neb.) to eliminate $42 billion in cuts over 10 years to agencies that provide home health care to seniors under Medicare. It went down on a 53 to 41 vote, but four Democrats – Lincoln, Nelson, Evan Bayh (Ind.) and Jim Webb (Va.) – crossed the aisle to join Republicans in supporting it.
In a move that drew Republican criticism, Lincoln initially voted with Democrats opposing the amendment, but switched her vote within the 15-minute window to "yes" after it became clear that the measure would not pass.
Sen. John Kerry (D-Mass.) responded with an alternative amendment stating that the new health bill would not reduce guaranteed home health benefits that passed on a 96-0 vote.
Amendments aide, Harkin suggested every senator in the room was open to the negotiations because they all want to pass a bill.
“Oh, we all say strong things around here, but I’ve never seen a senator yet who isn’t willing to compromise,” Harkin said. “We all agree we want a bill and to move forward.”
Rockefeller concurred: “My general view is that those statements have been part of floor conversations, conversations with the press, but when you go into these kinds of things they're less said because there you all are.”
Following an afternoon session, Rockefeller said the group made "more progress than we’ve made in any meeting so far.”
"People are open in ways that they have not been open before," he said. "Sometimes people just out of sheer fatigue can agree to things.”
Senators said they were hoping Obama would provide more direction during their Sunday afternoon caucus meeting.
Harkin said he wants the president “to take leadership, that is what the president is supposed to do, to use his bully pulpit.”
Asked if Obama has done that so far, Harkin said: “I haven’t seen much of it, no.”
In the past week, abortion has flared up as a major impediment to passage of a health care reform bill in the Senate, taking a similar path as it did during the House debate — from obscurity to obstacle in a matter of days.
After months of trying to craft a 60-vote coalition based on the finer points of health care policy, Senate Democrats are growing increasingly worried that abortion will upend what had become a clear path to approving the overhaul bill.
Sen. Ben Nelson (D-Neb.) sparked a fresh round of concern this week when he repeatedly and definitively vowed to filibuster the health care legislation unless it included abortion restrictions as tough as the so-called Stupak amendment in the House bill.
“I don’t ordinarily draw a line in the sand, but I have drawn a line in the sand,” Nelson said Friday.
Nelson certainly has a long history of agitating his party by withholding his vote until he wrings out every last concession from Senate leaders. But on the uncompromising issue of abortion, Democrats fear he may really be serious this time.
“There is a worry that Sen. Nelson means business,” said a senior Senate Democratic aide, who spoke on the condition of anonymity to discuss strategy. “Unlike with public option, there is very little ground liberal Democrats are willing to give on this issue. Abortion, not the public option, may be the cause of our first official defection.”
The United States Conference of Catholic Bishops, which proved highly influential in the House health care debate, is assisting Nelson and Sen. Orrin Hatch (R-Utah) in drafting an anti-abortion amendment, and its representatives are meeting with senators, including Byron Dorgan (D-N.D.).
The bishops have also sent a nationwide bulletin insert to its parishes for Sunday Mass, according to a source familiar with the plans. The conference rallied parishioners in a similar way ahead of the House vote. The bishops conference didn’t return calls seeking comment.
Advocacy groups on both sides of the issue are using the weekend to mobilize supporters ahead of a debate that could begin as early as Monday. Senate Majority Leader Harry Reid (D-Nev.) had expected to dispense with the abortion amendments by the weekend, but Nelson sought more time.
“Delay is always good,” said Charmaine Yoest, president and CEO of Americans United for Life, a group that opposes abortion.
For months, Senate Democrats have been gaming out various paths to 60 votes on the other major intractable problem — a government insurance plan. They continue to struggle with a solution, but there is a growing sense a compromise can ultimately be forged and it would not be the reason the bill fails.
“On abortion, nobody is in a mood to deal at all,” the aide said.
The abortion debate that unfolded in the House caught abortion rights supporters off guard, and they have been as unbending as abortion opponents on the Stupak amendment, which prohibits individuals from using federal subsidies to buy policies that cover abortion. Abortion rights supporters say the language could force insurers from offering abortion coverage in any of their plans, potentially limiting access to the procedure for millions of women.
“We are going to defeat it,” said Sen. Barbara Boxer (D-Calif.) of Nelson’s amendment, which is expected to closely mirror the Stupak language.
Asked if he believed abortion could derail the health care bill, Sen. Kent Conrad (D-N.D.) didn’t hesitate: “Yes, absolutely.”
“Clearly, this is one of the major challenges facing this bill,” said Conrad, who votes with abortion opponents. “The settled policy of the government is that there is not taxpayer funding of abortion, and we are trying to continue that policy. It is very complicated in the context of an exchange and a public option to continue the Hyde amendment policy that has long been in place. Lots of smart people working on ways to try to be able to ensure people that is the case, on both sides. We have not reached a conclusion.”
Reid plans to schedule several votes on the issue to “demonstrate that the 60 votes are not there,” a Senate Democratic leadership aide said.
If Nelson’s amendment fails, which is expected, the question at that point is what would he do — and how does Reid get to 60 votes on the overall bill without him?
Nelson told POLITICO this week that he would not walk away from the negotiations if the Senate rejects his amendment. “No, no, no. I’m a facilitator,” he said. “If this bill is going to pass without me, I still want it to be the best bill.”
Reid could attempt to reach a compromise that forces both sides to give up something, and include the new language in a “manager’s amendment” that goes up for a vote right before debate ends on the bill.
Or else, the majority leader may need to go aggressively after one or both of the Maine Republicans, Olympia Snowe and Susan Collins, who support abortion rights. That could mean major concessions on the public option, taxes and the mandate on individuals to purchase insurance — aspects of the Democratic bill that they oppose.
Senate Majority Whip Dick Durbin (D-Ill.) said he expected Democrats to find a compromise that brings Nelson along.
“At the end of the day, we need Sen. Nelson’s vote. We still don’t have a promise of a vote from the Republican side, and so we would need his vote to make our 60,” Durbin told reporters in a conference call Friday.
Durbin didn’t specify what kind of compromise would bring Nelson on board. He said the Senate will consider Nelson’s amendment when the Nebraska Democrat is ready to bring it to the floor, but leadership is encouraging him to go ahead without Hatch, who indicated he needed more time to review the amendment with outside groups.
Nelson, however, was quick to bat down any notion of a compromise.
“No,” Nelson said Friday, when asked if he would accept softer language. “I don’t want to start talking about compromises before I have an opportunity to offer something.”
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