The future of President Obama’s
health care overhaul now rests largely with two blocs of swing
Democrats in the House of Representatives — abortion opponents and
fiscal conservatives — whose indecision signals the difficulties
Speaker Nancy Pelosi faces in securing the votes necessary to pass the bill.
With Republicans unified in their opposition, Democrats are drafting
plans to try on their own to pass a bill based on one Mr. Obama
unveiled before his bipartisan health forum last week. His measure hews
closely to the one passed by the Senate in December, but differs
markedly from the one passed by the House.
That leaves Ms. Pelosi in the tough spot of trying to keep wavering
members of her caucus on board, while persuading some who voted no to
switch their votes to yes — all at a time when Democrats are worried
about their prospects for re-election.
Representative Dennis Cardoza, Democrat of California, typifies the
speaker’s challenge. The husband of a family practice doctor, he is
intimately familiar with the failings of the American health care
system. His wife “comes home every night,” he said, “angry and
frustrated at insurance companies denying people coverage they have
paid for.”
But as a member of the centrist Blue Dog Coalition, Mr. Cardoza is not
convinced that Mr. Obama’s bill offers the right prescription. It lacks
anti-abortion language he favors, and he does not think it goes far
enough in cutting costs. So while he voted for the House version —
“with serious reservations,” he said — he is now on the fence.
“I think we can do better,” Mr. Cardoza said of the president’s proposal.
Representative Frank Kratovil Jr., Democrat of Maryland, is also
unconvinced. He voted against the House bill on the grounds that it is
too big and too costly — a view that some constituents in his
Republican-leaning district share. In case he did not get the message,
one of them hanged him in effigy this past summer outside his district
office on the Eastern Shore of Maryland.
“This system is broken; we have to do something,” Mr. Kratovil said. “But my preference would be to do smaller things.”
Under the Democrats’ tentative plans, the House would pass the health
care bill approved in December by the Senate, and both chambers would
approve a separate package of changes using a parliamentary device
known as budget reconciliation.
The tactic is intended to avoid a Republican filibuster, but in the Senate, the majority leader, Harry Reid of Nevada, faces challenges if he tries to use it. He is having trouble persuading a majority of his caucus to go along.
In the House, lawmakers like Mr. Kratovil, Mr. Cardoza and other swing
Democrats will come under increasing scrutiny from leadership as a vote
draws near. Of the 219 Democrats who initially voted in favor of the
House measure, roughly 40 did so in part because it contained the
so-called Stupak amendment, intended to discourage insurers from
covering abortion.
Some, notably Representative Bart Stupak,
the Michigan Democrat for whom the amendment is named, will almost
certainly switch their yes votes to no because the new version being
pushed by Mr. Obama would strip out the House bill’s abortion
restrictions in favor of Senate language that many of them consider
unacceptable.
An additional 39, like Mr. Kratovil, are fiscal conservatives who voted
no the first time around. Ms. Pelosi is hoping that she can get some to
switch those no votes to yes in favor of Mr. Obama’s less expensive
measure.
But persuading Democrats who are already on record as opposing a health
overhaul to do a turnabout will not be an easy task, especially during
a midterm election year in which Democrats’ political prospects already
look bleak. Of the 39 Democrats who voted against the House measure,
31, including Mr. Kratovil, represent districts that were won in 2008
by Senator John McCain
of Arizona, Mr. Obama’s Republican rival. Fourteen, including Mr.
Kratovil, are freshmen, who are generally considered more politically
vulnerable than more senior lawmakers.
“The concern among Democrats right now is that there are more yes votes
reconsidering than no votes,” said David Wasserman, who tracks House
races for the nonpartisan Cook Political Report. “My sense is that for
Democrats to pass this bill, they would have to convince several
members who are already in serious jeopardy, even after voting no on
the first health care bill, to put passage of the bill ahead of their
own chances of being competitive in the fall.”
But politicians do not want to be martyrs. They want to hold onto their seats.
Ms. Pelosi is facing resistance from some of her most senior members,
like Representative Ike Skelton, Democrat of Missouri and chairman of
the Armed Services Committee. He has been in office since 1977, but is
facing his toughest re-election challenge in years.
Mr. Skelton says he does not see any improvements in the measure that
would cause him to vote in favor of it; like Mr. Kratovil, he favors a
smaller, less ambitious bill. “It would be a lot easier,” he said, “if
we cut this back to basics — take two or three or four issues on which
everyone agrees and build on it.”
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