Democrats wary of health-bill defections
Immigration and abortion issues could cost party crucial votes

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Friday, November 6, 2009

House Democratic leaders were struggling Thursday to contain uprisings on the hot-button issues of abortion and immigration that have left them little margin for error as they attempt to push through a massive health-care reform bill this weekend.

Although confident of victory, House Speaker Nancy Pelosi (Calif.) and other Democratic leaders were working to limit defections to the roughly 25 Democrats viewed as "hard no" votes. There will be 258 Democrats in the House by the time the vote takes place, but to secure the 218 votes needed for passage -- and with prospects dim for Republican converts -- Pelosi can afford to lose no more than 40 members of her caucus. President Obama had been slated to head to the Hill on Friday to push wavering Democrats to get behind the measure, but he called off the trip after Thursday's shooting rampage at Fort Hood, Tex.

For party leaders, setting a weekend deadline for passage represented a calculated risk, one that could backfire if the vote -- now expected late Saturday or Sunday -- fails or must be delayed. But they feared that if members were given more time to consider the legislation, new issues could arise, particularly as lawmakers digest the results from Tuesday's elections. Most ominous for Democrats were their losses in gubernatorial contests in New Jersey and Virginia, although the party did prevail in House special elections in New York and California.

The legislation's prospects got a boost with key endorsements Thursday from AARP, the American Medical Association and the American Cancer Society. But Pelosi was still working Thursday night to chip away resistance from antiabortion Democrats, who worry the bill could lead to government funding of the procedure, and from Hispanic members trying to stave off efforts to add a Senate provision that would bar illegal workers from buying private insurance policies through new federally established marketplaces, even with their own money.

"We are right on the brink of passing historic legislation to provide quality, affordable, accessible health care for all Americans," Pelosi told reporters. Asked whether she had the votes to bring the bill to the House floor, the California Democrat pledged, "We will."

The legislation's next stop is the Rules Committee, which is scheduled to meet Friday afternoon to establish a framework for a historic debate on the biggest expansion of health coverage since Medicare and Medicaid were created in 1965. Committee Chairman Louise M. Slaughter (D-N.Y.) said that more than 50 amendments had been filed by members of both parties and that debate is expected to consume at least five hours of floor time on Saturday. Procedural maneuvering by Republicans could extend that period by several hours and possibly into Sunday.

The final House bill is expected to vary only slightly from the 1,990-page document Democratic leaders unveiled amid great fanfare last week. In addition to a 42-page "manager's amendment" released late Tuesday, Slaughter's committee will approve the guidelines governing the debate. That rule, she said, is likely to contain a provision aimed at quelling a long-simmering dispute over abortion that has slowed progress in the House for weeks.

As written, the House bill would allow plans offered through new insurance exchanges, set up for individuals without employer coverage, to cover abortion services. But the plans would be required to establish payment firewalls to prevent federal subsidies from covering the cost. Democrats opposed to abortion call that an accounting distinction and are seeking ironclad guarantees.

A compromise measure crafted by Rep. Brad Ellsworth, an antiabortion Democrat from Indiana, would require federal health officials operating the public insurance plan created in the House bill to hire a private contractor to pay abortion providers, thus avoiding direct federal payments. That language is acceptable to Democrats who support abortion rights, but not to many Democrats who oppose abortion, and House leaders were still working Thursday night to craft language that would win back a dozen or so of the 40 Democrats whose votes may be on the line.

As the hours ticked away, Democrats scrutinized the House bill for other potential landmines that could haunt them on the campaign trail next year. Immigration, and the prospect that Republicans will identify a loophole that could be construed as benefiting people who live in the United States illegally, is one area that is receiving a great deal of attention.

Rep. Gerald E. Connolly (Va.), president of the Democratic freshman class, said he wants to be able to assure his constituents that people "who are here illegally cannot avail themselves of the infrastructure that we're creating," although he said he is not necessarily opposed to letting undocumented workers buy insurance through the exchanges on their own. Connolly said he is leaning toward voting in favor of the measure, but he added: "I want to read the language. I can't afford to be voting for something sight unseen."

Party leaders are considering relenting on the more restrictive Senate language on illegal immigrants, in the hope of removing a contentious issue from the long list of concerns that must be worked out in a final House-Senate conference. That concerns wavering Hispanic members.

"Yes, you have someone here illegally, that's a bad thing," said Rep. Charlie Gonzalez (D-Tex.). "But they are here. And someone's hiring them, by the way, and paying them. And they want to be responsible for their health care. We're going to have a provision that disallows them from purchasing a private plan."

The lawmakers made their case in a meeting with Obama on Thursday afternoon, but they said they received no commitment. Rep. Nydia M. Velázquez (D-N.Y.) said that the Hispanic caucus has 20 votes riding on the issue and that if the language changes, "I guess they won't have those 20 votes." She said of Obama, "He listened to us, and he knows where we stand."

Of Thursday's endorsements, the most significant is from AARP, the nation's largest and most influential association of older Americans, which has vowed to lobby House members in advance of the vote. Republicans have blasted the House bill as potentially devastating for seniors, pointing to more than $400 billion in Medicare cuts over the next 10 years.

AARP Vice President Nancy A. LeaMond said the House package would actually strengthen Medicare, the federal health program for people 65 or older, by restraining the program's costs. Congressional budget analysts have said the proposed reductions in spending would add five years to the life of the Medicare trust fund. Hospitals and other providers, meanwhile, have vowed to absorb the reductions without affecting services to seniors.

"We can say with confidence that it meets our priorities for protecting Medicare, providing more affordable health insurance for 50-to-64-year-olds and reforming our health-care system," LeaMond said in a news briefing.

She praised House leaders for including a plan to close the coverage gap in the Medicare prescription drug program known as the "doughnut hole." Key Democrats said the group's backing could prove critical to pushing their vote total over the top.

Obama called the AARP boost "no small endorsement" and told reporters at the White House, "So I want everybody to remember that the next time you hear the same tired arguments to the contrary from the insurance companies and their lobbyists. And remember this endorsement the next time you see a bunch of misleading ads on television."

Staff writer Scott Wilson contributed to this report.

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