Health bill compromises won over holdouts

By Paul Kane and Perry Bacon Jr.
Washington Post Staff Writer
Monday, November 9, 2009

So much for the political power of the public option.

Reps. Baron P. Hill (Ind.), elected with the class of 2006 that gave Democrats the House majority, and Dan Maffei (N.Y.), who rode to office with President Obama on a Democratic wave last year, were among the last lawmakers to make up their minds on Saturday's historic health-care vote.

Both voted yes, helping to push the count to a razor-thin majority of 220. Neither viewed the much-hyped furor over the creation of a government-run option to compete with the private insurance industry as a major factor in their decisions. For Hill -- and a couple of dozen other Democrats -- the decision came down to a last-minute compromise that paved the way for an amendment ensuring that no federal funding would go to abortions. For Maffei, it was a long series of discussions with staff, experts, his constituents and Obama.

"I've always wanted to get to yes," Hill, who was part of a conservative Democratic blockade to the legislation in July, said after voting to approve the legislation.

"It's pretty closely divided. Either way, it would have been a profile in courage or a profile in being ordinary," Maffei, a former Capitol Hill staffer, said of public opinion in his Syracuse-based district.

House Speaker Nancy Pelosi (D-Calif.) and her leadership team won a hard-fought victory on Obama's most critical domestic policy agenda item by neutralizing the most potentially toxic political issue well in advance of the final vote, siding with centrists on their preferred version of the public option. She then publicly dared the progressive wing, with its strong commitment to establishing national health insurance, to take down the entire package because one piece was not to their liking.

The progressives blinked. Only two, Reps. Dennis J. Kucinich (D-Ohio) and Eric Massa (D-N.Y.), lived up to the July pledge signed by roughly 60 liberals in which they vowed to vote against the bill if it did not contain their favored version of public option.

With that fight out of the way, Pelosi's team spent the last 10 days soothing the political egos of wavering lawmakers on more easily negotiated issues such as abortion funding and medical device taxes. With a caucus of 258, Democrats knew they could afford up to 40 defections and still reach the magic number of 218 votes without any GOP support. (One Republican, Rep. Ahn "Joseph" Cao (La.), did vote yes, but only after Democrats recorded their 218th vote as the clock approached midnight Saturday.)

Election pressures

The Democratic drubbing in gubernatorial elections in Virginia and New Jersey provided a final stark reminder of the stakes lawmakers faced over their Saturday votes. Independents abandoned Democrats and told pollsters they were deeply concerned about deficit spending and the takeovers of private industry.

But leaders repeatedly told rank-and-file Democrats that the bigger concern would be failure to deliver on an issue critical to liberal voters, fearing the combination of an energized conservative grass roots and a depressed liberal base in next fall's midterm elections. "When I sign this bill in the Rose Garden, each and every one of you will be able to look back and say, 'This was my finest moment in politics,' " Obama told Democrats at a closed-door pep rally before Saturday's vote.

The push resulted in a broad cross-section of support from all corners of the caucus. More than half of the 52-member Blue Dog Coalition -- most from conservative-leaning districts -- supported the legislation. Of the 37 freshman lawmakers elected in 2008 or in special elections since, just 14 opposed the measure.

A tough vote

Moments before the vote, Pelosi and a host of senior Democrats gathered around Rep. Tom Perriello (D-Va.) in the back of the chamber, shaking his hand and slapping him on the back with broad smiles. Elected last year in a solidly conservative district, the son of a country doctor was about to support a bill that is not considered popular in southwestern Virginia. It was another very tough vote for a freshman who now has perhaps the largest political bull's-eye on his back from the national Republican Party.

Like Hill, Perriello wanted to support the legislation and was swayed by changes to the bill including provisions for bigger payments to rural doctors. "I've been working hard to get to 'yes' because the status quo is simply unsustainable and unacceptable," he said in an Oct. 30 statement.

Hill led the effort in July to craft a more moderate public option and demanded that the vote be put off until after the summer recess. It originally appeared to be a disastrous decision, as he and dozens of other Democrats were confronted by angry protesters at town halls protesting the "government takeover" of health care, making "public option" a household phrase. But he said the pause allowed lawmakers the chance to let their constituents voice their opinions, so that they could not be accused of rushing to a vote.

"I still think it was a smart move, despite the August break and what we went through. That's how democracy is supposed to work. You have to let the dissenters speak," he said.

Maffei's political concerns were eased by Tuesday's elections after Democrat Bill Owens won a longtime GOP-held neighboring district in a special election by campaigning in favor of the health-care legislation. The final sales pitch to Maffei came from Obama on Saturday, when Maffei listed his concerns on changes to a Medicare program for the rural elderly and the employer mandate to purchase insurance.

Making no commitments, Obama talked about voting to move the process forward.

"I think the majority of people support health-care reform, but this bill has flaws," Maffei said. "You can move the bill forward and fix some things before it goes to the president."

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