With Democrats finally coming around to the need to ignore Republicans and pass health reform through reconciliation, new obstacles to that goal—and challenges to passing any health reform this year—emerged Sunday.
Sen. Kent Conrad (D-ND), the chairman of the Senate Budget Committee and one of the Democrats who long opposed the public option, declared on Face the Nation, "Reconciliation cannot be used to pass comprehensive health care reform." Conrad overlooked, though, that the proposed fixes to the House and Senate bills by the White House are in fact budgetary changes, as Steve Benen of The Washington Monthly observes.
The political landscape has changed so profoundly since Democrats were shell-shocked by the Republican Senate victory in Massachusetts that a new wariness among centrists and vulnerable Democrats makes the challenge of passing a bill even harder. That's in part due to the failings of the administration in trying in vain to appease Republicans and conservatives while allowing right-wingers to dominate messaging, and of most mainstream advocacy groups in basically letting administration officials do so for so long -- while most liberals refrained until late last year from full-throated, high-profile attacks on health care corporations.
That, in turn, could have rallied the base while the White House was negotiating deals with those stakeholders. It may have seemed pragmatic at the time, but a White House that didn't give firm direction to Congress and a muted liberal wing of the Democratic Party produced legislation that's excited more opposition than passionate support.
Progressive critics are offering increasingly harsh assessments of the role of the Democratic leadership and the White House in undermining the now-fading public option, a dispute widening the division among liberals even as passage in the House rests on a razor-thin margin requiring centrists and conservaDems.
Yet Glenn Greenwald of Salon contends about Democratic leaders and the President: "They're willing to feign support for anything their voters want just as long as there's no chance that they can pass it. " At the same time, it's important to ask if spending time on trying to revive the public option is the best use of activists' time and resources when the rest of health care reform is in so much peril. Even if limited, the President's proposal does offer new coverage to 30 million currently without it and limit insurance industry abuses, cost-hikes and bans on pre-existing conditions.
At this point, though, it seems that most progressives in Washington, including the House Progressive Caucus, are now willing to support the President's bill without a public option. Meanwhile, the justifiably angry netroots activists are ramping up pressure on Senators to support it, with about 25 Senators signing a letter of support.
Some House leaders are predicting they'll have enough votes in the House, where centrist and conservative Democrats pose the biggest obstacle, but reform's prospects in the House -- and whether Democratic Senators will go along with reconciliation -- are still unclear. As the Hill reported:
On NBC's "Meet the Press," Chief Deputy Whip Debbie Wasserman Schultz (D-Fla.) agreed that the votes are there.
"When we start counting the votes will be there," she said.
Senate Majority Leader Harry Reid (D-Nev.) has not yet said whether or not he will use the reconciliation process to pass fixes to the bill. And it's not clear whether or not 50 senators will support its use.
Some expect that the House will pass the Senate bill and then approve President Barack Obama's fixes to the bill with the Senate approving the fixes using reconciliation. But House Speaker Nancy Pelosi (D-Calif.) said on ABC's "This Week" that Democrats are still finalizing their plan.
But it also remains unclear if the House can marshal the votes to pass a health bill on a second go-around. Republicans have said they don't but Democratic leaders have left it an open-ended question this week.
A key progressive interest group that can make a difference in passing a bill, labor, has so far given modest support to the President's package, but is eager to see more improvements in the legislation, even though time is running out as we get closer to election season. But even if labor and progressive leaders fall behind the President's realpolitick proposal, there's no massive outpouring of grass-roots activity on behalf of salvaging health reform in the House with Obama's modest plan. That's because, as one progressive advocate told me bluntly, "It's hard to get the base fired up about the compromise."
At the same time, interest groups for and against health reform are gearing up for what could be the final battle, with the health industry deploying eight lobbyists for each member of Congress. As the Washington Post reported:
Washington interest groups have burst back into action in hopes of bolstering or defeating a new Democratic push on health-care reform legislation, sparking another wave of rallies, lobbying efforts and costly advertising campaigns.
The fresh round offers a clear signal that the industries and advocacy groups most likely to be affected view the coming weeks as the final battle in determining whether Democratic proposals become law.
Their efforts suggest a return to the frenzied pace of last year's health-care debate, which prompted more than $200 million in advocacy ads and broke records for lobbying. Companies and trade groups last year hired more than 4,500 lobbyists to influence health reform -- amounting to about eight lobbyists for each member of Congress, according to an analysis released last week by the Center for Public Integrity.
Progressive groups also have their own plans, but it's not clear if their urgency can match the hostility of the right wing and the greed of most health industry players in stopping reform. As the Post noted:
Democratic and liberal activist groups, meanwhile, are rallying with their own efforts in hopes of pushing legislation across the finish line.
MoveOn.org, for example, said that a "virtual march" organized Tuesday bombarded lawmakers with more than 1 million pro-reform e-mails. The group also released a television ad Friday targeting House Minority Leader John A. Boehner (R-Ohio) for opposing the antitrust bill.
"We have the votes; let's get it done," said Ilyse Hogue, the group's political advocacy director. "We're focused on sending that clear message to the House and Senate."
One glaring exception to the renewed activity is AARP, the 40 million-member seniors group, which has spent millions on advertising and other efforts over the past year in favor of Obama's health-care plans. A. Barry Rand, the group's chief executive, called on other groups last week to lower the temperature in the debate so that "compromise is possible."
"We promise to make no new statements, send no new letters, run no new ads about health reform, and we are urging all other interest groups to do the same," Rand said in a statement. "Let's turn down the volume on the outside noise so that our leaders might actually listen..."
Organizing for America, the grass-roots arm of the Democratic National Committee, is tapping into Obama's 13 million-deep e-mail list to solicit campaign volunteers on behalf of Democrats who support health-care legislation, according to Lynda Tran, a spokeswoman. The effort has so far resulted in nearly 9 million hours of pledged volunteer work, Tran said; the idea is to guarantee electoral support for lawmakers nervous about the November midterm elections.
The group also launched a new campaign last week aimed at helping Obama supporters make their views known on talk-radio stations around the country, Tran said.
Richard Kirsch, national campaign director for the pro-reform group Health Care for America Now, said the organization plans a large-scale demonstration in Washington on March 9 targeting a policy conference by AHIP, the insurance lobby.
The group also ended an eight-day march last week from Philadelphia to Washington in honor of Melanie Shouse, an Obama supporter whom activists say died of breast cancer because she had no access to health insurance.
"The message we have is simple: Congress should listen to us, not the insurance industry," Kirsch said. "They have to make a decision and decide whose side they're on."
Amid the challenges of winning over centrist and conservative House Democrats concerned about abortion or deficits, progressives also need to keep in mind what will happen to not just Democratic election prospects but health care itself if Democrats fail now. As Reed Abelson points out in the New York Times:
Suppose Congress and President Obama fail to overhaul the system now, or just tinker around the edges, or start over, as the Republicans propose -- despite the Democrats' latest and possibly last big push that began last week at a marathon televised forum in Washington.
Then "my health care" stays the same, right?
Far from it, health policy analysts and economists of nearly every ideological persuasion agree. The unrelenting rise in medical costs is likely to wreak havoc within the system and beyond it, and pretty much everyone will be affected, directly or indirectly.
"People think if we do nothing, we will have what we have now," said Karen Davis, the president of the Commonwealth Fund, a nonprofit health care research group in New York. "In fact, what we will have is a substantial deterioration in what we have."
Nearly every mainstream analysis calls for medical costs to continue to climb over the next decade, outpacing the growth in the overall economy and certainly increasing faster than the average paycheck. Those higher costs will translate into higher premiums, which will mean fewer individuals and businesses will be able to afford insurance coverage. More of everyone's dollar will go to health care, and government programs like Medicare and Medicaid will struggle to find the money to operate.
UPDATE: House Speaker Nancy Pelosi declared Sunday that she's confident there will be enough votes in the House to pass healthcare reform. As The New York Times reported:
In an interview carried Sunday on ABC’s “This Week,” Ms. Pelosi said she was working on changes to a Senate-passed bill that would make it acceptable to the House.
Ms. Pelosi was asked what she would say to House Democrats who were “in real fear of losing their seats in November if they support you now.”
“Our members, every one of them, wants health care,” Ms. Pelosi said. “They know that this will take courage. It took courage to pass Social Security. It took courage to pass Medicare. And many of the same forces that were at work decades ago are at work again against this bill.”
“But,” Ms. Pelosi continued, “the American people need it. Why are we here? We’re not here just to self-perpetuate our service in Congress. We’re here to do the job for the American people, to get them results that give them not only health security, but economic security.”