On health-care bill, Democratic senators are in states of denial

By Dana Milbank
Tuesday, December 22, 2009; A02

Formally, it is known as H.R. 3590, the Patient Protection and Affordable Care Act. But this week, it has acquired an unhelpful nickname: "Cash for Cloture."

As Senate Democrats finally complete their health-care legislation, those combing through the bill have uncovered many backroom deals that were made to buy, er, secure the 60 votes needed to "invoke cloture" -- the legislative term for cutting off debate and holding a final vote.

It will take years to see how well the measure reduces costs and expands insurance coverage. But already, the bill has been a bonanza for wordsmiths.

First there was the "Louisiana Purchase," $100 million in extra Medicaid money for the Bayou State, requested by Sen. Mary Landrieu (D-La.).

Then came the "Cornhusker Kickback," another $100 million in extra Medicaid money, this time for Sen. Ben Nelson (D-Neb.).

This was followed by word that Sen. Christopher Dodd (D-Conn.) had written into the legislation $100 million meant for a medical center in his state. This one was quickly dubbed the "U Con."

Earlier, when GOP staff member mistakenly thought the medical center was destined for Indiana rather than Connecticut, they named it the "Bayh Off" for Sen. Evan Bayh (D-Ind.).

For Democratic leaders, this created an appearance problem. Fortunately, they had removed from the bill the tax on cosmetic procedures (the "Botax") and replaced it with a tax on tanning (which would primarily impact House Minority Leader John Boehner of Ohio).

"I don't know if there is a senator that doesn't have something in this bill that was important to them," Senate Majority Leader Harry Reid (D-Nev.) reasoned when asked at a news conference Monday about the cash-for-cloture accusation. "And if they don't have something in it important to them, then it doesn't speak well of them."

Indeed, the proliferation of deals has outpaced the ability of Capitol Hill cynics to name them.

Gator Aid: Sen. Bill Nelson (D-Fla.) inserted a grandfather clause that would allow Floridians to preserve their pricey Medicare Advantage program.

Handout Montana: Sen. Max Baucus (D-Mont.) secured Medicare coverage for anybody exposed to asbestos -- as long as they worked in a mine in Libby, Mont.

Iowa Pork and Omaha Prime Cuts: Sen. Tom Harkin (D-Iowa) won more Medicare money for low-volume hospitals of the sort commonly found in Iowa, while Nebraska's Nelson won a "carve out" provision that would reduce fees for Mutual of Omaha and other Nebraska insurers.

Meanwhile, Sens. Byron Dorgan and Kent Conrad, both North Dakota Democrats, would enjoy a provision bringing higher Medicare payments to hospitals and doctors in "frontier counties" of states such as -- let's see here -- North Dakota!

Hawaii, with two Democratic senators, would get richer payments to hospitals that treat many uninsured people. Michigan, home of two other Democrats, would earn higher Medicare payments and some reduced fees for Blue Cross/Blue Shield. Vermont's Sen. Bernie Sanders (I) held out for larger Medicaid payments for his state (neighboring Massachusetts would get some, too).

As news of the agreements proliferated, Republican senators went to the floor to protest. "This will not stand the test of the Constitution, I hope, because the deals that have been made to get votes from specific states' senators cannot be considered equal protection under the law," argued Sen. Kay Bailey Hutchison (Tex.).

Her Texas colleague, Sen. John Cornyn, took issue with White House strategist David Axelrod's claim that such deals are "the way it will always be." Said the Texan: "Maybe in Chicago, but not in my state, and not in the heartland."

Sen. Mike Johanns (R-Neb.) even disavowed Nelson's Cornhusker Kickback. "Nebraskans are frustrated and angry that our beloved state has been thrust into the same pot with all of the other special deals that get cut here," he reported.

The accusations must worry Democrats, for Sen. Michael Bennet (Colo.), facing a difficult 2010 reelection contest, went to the Senate floor to declare: "I'm not happy about the backroom deals."

Baucus, the Finance Committee chairman, felt the need to go to the floor to explain why he is "particularly proud" of the provision he inserted that would extend Medicare coverage to workers sickened by asbestos in Libby. But he wasn't proud enough to name Libby, or Montana, in the legislation. To prove that Libby is needy, Baucus displayed a photo from the town saying, "Warning: Stay Out."

Harkin, chairman of the Senate health committee, followed Baucus to the floor to explain why he added the provision that would help Iowa (and "a few other states"). "I don't see anything wrong with that," Harkin said. "I make no bones about having put that in there."

Dodd, at a news conference, offered the dubious argument that the hospital provision he offered is "competitive" and could be won by another state, "although my state is very interested."

But what about those who wouldn't get the goodies? Sen. Blanche Lincoln (D-Ark.) walked away with little to show for her politically difficult vote.

"That's what legislation is all about: It's the art of compromise," Reid said when asked about the fairness of it all. "So this legislation is no different than the defense bill we just spent $600 billion on." That would be the bill with more than 1,700 pet-project earmarks. "It's no different than other pieces of legislation," Reid continued.

And that's just the problem.

View all comments that have been posted about this article.

© 2009 The Washington Post Company