The Take

The Take: On Health-Care Stage, Spotlight Is Now on Obama

By Dan Balz
Wednesday, September 30, 2009

For many months, advocates of health-care reform have implored President Obama to outline in greater detail the provisions he's prepared to push and defend. So far, he has largely resisted, offering broad principles and leaving the details to Congress. But the time of hanging back is quickly coming to an end if he hopes to find the 60 votes needed to pass a bill in the Senate.

Tuesday's votes in the Senate Finance Committee opposing the creation of a public health insurance option -- five Democrats and then three voted against it -- moved the health-care debate to a new point, though one long anticipated.

With all Republicans and a number of centrist Democrats, including Finance Committee Chairman Max Baucus (D-Mont.), opposed to the public option, it has been clear for some time that it would not survive debate in the committee. The idea now faces potentially insurmountable odds in the full Senate, though proponents vowed to keep pushing for it.

Obama favors the public option but has strongly signaled his willingness to allow it to die if that is the price of winning broader support for overhauling the health-care system. He will soon have to choose between those Democrats who want it, including many of his most passionate backers from last year's election, and those who don't. And he will have to persuade the losing side to stick with him, regardless.

There will be more for the president to adjudicate once Senate Majority Leader Harry M. Reid (D-Nev.) begins trying to meld together the Finance Committee bill, expected to be completed by the end of this week, with a more liberal version approved by the Senate Health, Education, Labor and Pensions Committee.

The votes Tuesday on the public option were the most dramatic decisions during September, though much else has happened since lawmakers returned to prepare for the final chapters of the long debate. Preliminary work has begun behind the scenes, including assessments of whose votes may be most difficult to secure and what it may take to get them.

The story of August was all about angry town hall meetings and eroding support for the president's top domestic initiative. September eventually may be seen as a month in which the erosion stopped, public opinion began to tick back in the other direction, however imperceptibly, and the White House and congressional leaders began to set the table for eventual passage of the bill.

Much now will depend on the president's leadership. October could be all about Obama, and whether he and his White House team can solve the remaining issues of cost, affordability and coverage to pass a health-care bill in the Senate and move it to a conference committee with the House.

White House officials and Senate leaders are frank in their assessment that they don't have the 60 votes necessary to pass a bill. Sen. Charles E. Schumer (D-N.Y.), who sponsored a public option amendment that was defeated Tuesday, acknowledged that reality during deliberations.

The health-care debate has been marking time as the Finance Committee negotiates. House leaders are awaiting the Senate panel's decisions before combining various measures in a final package that will go to the floor, though Speaker Nancy Pelosi (D-Calif.) has long insisted that the public option must be included in the House bill.

Reid will be at the center of the Senate discussions. He will create, in essence, a mini-conference committee in that chamber, comprising members of the health and finance panels, White House officials and his own team. Under Reid's leadership, these groups have been meeting to find agreement between the Senate bills to prepare for the big debates.

While some analysts have assumed that the Finance Committee bill will form the basis for a Senate measure, a few Democrats argue that, because neither bill could attract 60 votes, each must give ground on key issues.

Although this will be a discussion mostly among divided Democrats, Sen. Olympia J. Snowe (R-Maine) will play a pivotal role. Her support for the bill remains crucial, if only for providing a patina of bipartisanship.

Democrats believe there is room for further negotiation with her, in part because the Finance Committee bill does not include some provisions she favors. One Senate staffer said Democrats like some of the elements of Snowe's wish list more than her Republican colleagues on the committee did.

Beyond Snowe, there are seven or eight centrist Democrats whose support is still not certain. The White House has been wooing these lawmakers but also will have to mollify liberals if the public option is jettisoned.

Reid has made clear that he is looking for considerable help from the president as the Senate begins the next phase. If the plan's proponents can't get 60 votes, they will have to follow the route of reconciliation, which would require 51 votes for passage.

But it's doubtful that some of the insurance reforms championed by Democrats (and some Republicans), such as prohibiting insurance companies from denying coverage for preexisting conditions, can be included in a reconciliation package. That is why the goal remains 60, one way or another.

What September has shown is that Democrats are still committed to passing a bill. But Obama and his party have a difficult road ahead. No one yet has the formula that will attract the necessary votes. Senators are looking to the president to help make it happen.

© 2009 The Washington Post Company