The political world's winners and losers in health-care reform

By Chris Cillizza
Washington Post Staff Writer
Monday, December 21, 2009; A02

With all 60 Senate Democrats (finally) lined up behind the health-care bill, the legislation looks likely to be approved by the world's greatest deliberative body by Christmas Eve.

The Fix's gift to you, loyal reader? A look back on the fight that was -- and what a fight it was! -- to see who won and who lost.


-- President Obama: Did the White House underestimate the challenge of reforming the health-care system? Absolutely. And, the months of process-based stories on the warring Democratic factions and declining poll numbers were the price they paid for that miscalculation. But ultimately Obama -- once he persuades the House to go along -- will get a health-care reform package through Congress, a legislative feat of epic proportions.

-- Harry Reid: Reid may not be a terribly impressive politician in front of the camera, but behind closed doors he is without peer. Reid managed to divine what each of the 60 members of his fractious caucus needed to be a "yes" and give it to them without permanently hobbling the bill. Hard to argue with that kind of result.

-- John McCain: The Mac was back during the health-care debate, a feisty presence on the Senate floor and in front of the television cameras, leading the GOP opposition to the bill. McCain's performance over the past several weeks proved that he is and will continue to be a major force in the chamber. His stalwart opposition to the plan is also good politics, making it harder for former representative J.D. Hayworth to challenge him from the ideological right in a primary next year.

-- Ben Nelson: The Nebraska senator played the legislative process like a virtuoso, not only getting stricter language about abortion funding included in the final bill but also scoring another huge plum -- the promise of full federal funding for the expansion of Medicaid in the Cornhusker State. Of Nelson's bargaining, one Senate Democratic operative said: "A one-man study on how the Senate works -- they should teach this in civics class."

-- The National Republican Senatorial Committee: Strategists at the Senate GOP campaign arm were rejoicing over the weekend with the news that targeted Democrats including Blanche Lincoln (Ark.) and Michael Bennet (Colo.) were going to vote for the measure. Unlike Nelson or even Louisiana Sen. Mary Landrieu (D), who is up for reelection in 2012, neither Lincoln nor Bennet got anything major in exchange for their vote -- meaning they could face the blowback from those unhappy with the legislation in their respective states without an accompanying sweetener to make the bill more palatable. And, will the vote of Sen. Byron Dorgan (D-N.D.) for the package be just the leverage the NRSC needs to get Gov. John Hoeven (R) into the race?

-- Tom Coburn: The Oklahoma Republican's procedural maneuvering -- including demanding the bill be read aloud -- had his Democratic colleagues living in fear of what he might pull out of his bag of tricks next. And, despite his hard work to kill the bill, Coburn's upfront attitude about his opposition kept him from attracting too much ire from his Democratic colleagues.

-- C-SPAN: Not since the "nuclear option" debate on federal judges have so many people tuned in to the Fix's favorite network to get a close-up look at the arcana of Senate procedure. They are reading the manager's amendment! They are reading the manager's amendment!


-- Harry Reid: Yes, the majority leader got the bill through -- a major victory for Democrats at the national level. But, back home in Nevada, the legislation remains a mixed bag (at best) politically and Reid now owns it. Reid has to hope public perception of the bill shifts in a positive direction in the coming months, as his numbers in the state are dismal and he has little margin for error.

-- Joe Lieberman: Lieberman's high-profile opposition to the Medicare buy-in effectively killed the public option. Lieberman allies insist that the Connecticut independent was protecting moderate Democrats such as Lincoln by putting himself on the firing line, but the practical political effect of his maneuvering has been to further anger and energize the party's liberal base against him. Beating Lieberman in 2012 -- if he chooses to run -- will be a cause cèlébre among the liberal left.

-- Cap and trade: No matter what Obama and his advisers said last week in Copenhagen, there is now no chance that the administration's climate-change proposal will come up for a vote in the Senate prior to the 2010 election. Politicians never like casting controversial votes, but they like doing so even less in an election year.

-- Liberals: Progressives both in and outside the Senate watched as their dream bill slowly but surely lost the elements -- including the public option -- they longed for. Compromise is the name of the game when it comes to passing legislation as complex and sweeping as health-care reform, but that's not likely to be much consolation for a Democratic base already aggrieved about Obama's decision to send more troops to Afghanistan.

The big barometer

A new voter analysis of every midterm election from 1978 through 2006 suggests that the single most important number in determining how many House seats will be won or lost by the party in power is the president's job-approval score in the months leading up to the election.

The analysis, done by the Democratic polling firm of Bennett, Petts & Normington and obtained by the Fix, concludes that "large losses of more than 20 seats have only occurred when the president's approval rating has fallen significantly below 50 percent."

The four elections in which significant seat shifts happened -- 1978 (Democrats lost 15), 1982 (Republicans lost 26), 1994 (Democrats lost 54) and 2006 (Republicans lost 30) -- all corresponded with weak presidential job-approval numbers in the two months before voters cast ballots.

By contrast, in the four midterms in which the president carried an approval rating above 50 percent, his party either gained seats (in 1998 and 2002) or suffered minimal defeats -- a five-seat GOP setback for Ronald Reagan in 1986 and an eight-seat loss for George H.W. Bush in 1990.

Given the conclusiveness of that data, both parties are right to keep a close eye on Obama's standing with the American people over the next 10 months. In the latest Washington Post-ABC News poll, 50 percent of the public approved of the job Obama was doing, data consistent with other surveys gauging perception of the president's job performance.

If that number goes up by five percentage points between now and Election Day 2010, history suggests Democrats will be looking at small-scale losses in the House. If it goes down by five points, the party's 40-seat majority could well be cut by half (or more).


Jen Psaki's rapid rise in Democratic operative circles continues apace with her promotion to deputy communications director at the White House. Psaki takes the place of Dan Pfeiffer -- Georgetown Hoya, class of 1998 -- who ascended to the top job following the departure of media consultant Anita Dunn. Psaki, a Connecticut native, cut her political chops as a spokeswoman for the Democratic Congressional Campaign Committee during the 2006 election cycle and also worked on the 2004 presidential campaign of Sen. John Kerry (Mass.).

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