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How Obama revived his health-care bill

By Ceci Connolly
Washington Post Staff Writer
Tuesday, March 23, 2010; A01

It was the Barack Obama the American public rarely sees -- irritated and wondering if he had arrived at the moment of defeat. ¶ Shortly after 6 p.m. on Jan. 19, with a political crisis about to explode, the president summoned the two top Democrats in Congress to the Oval Office for a strategy session. ¶ House Speaker Nancy Pelosi (D-Calif.) sat alongside Senate Majority Leader Harry M. Reid (D-Nev.), the tension in the room acute.

Obama wasn't waiting for the polls to close in Massachusetts at 8 that evening. He already knew that his Democratic Party was about to suffer an embarrassing loss. In the bitterest of ironies, the Senate seat held for nearly 47 years by Democrat Edward M. Kennedy, who had been the leading voice in Congress for universal health care, was about to fall into Republican hands.

Now the president was asking members of his assembled brain trust: What were they going to do?

Although they shared Obama's desire to vastly expand the nation's health-care system, they were divided over how to salvage his signature policy proposal.

Mathematically, Scott Brown's impending victory would deny Democrats a filibuster-proof majority in the Senate. With only 59 votes loosely under his control, Reid wanted the House to adopt the version of the health-care bill that had barely squeaked through the Senate on Christmas Eve.

No way, said Pelosi.

"The Senate bill is a non-starter," she said. "I can't sell that to my members."

Pelosi lectured the others about the political realities of the House: Her Democratic troops did not trust the Senate, and she would face a mutiny if she asked them to do what Reid was suggesting.

They talked over each other, round and round, repeating the arguments Obama had heard for weeks.

"Let me finish," he broke in.

This was not how the president had envisioned things. He was just one day away from celebrating his first year in office. By now, he was to have signed into law a landmark bill guaranteeing health care to every American, the broadest piece of social policy legislation since President Lyndon B. Johnson's Great Society.

Instead, he was confronting the very real prospect of failure on an equally grand scale.

The remarkable change in political fortunes thrust Obama into a period of uncertainty and demonstrated the ability of one person to control the balance of power in Washington. On Jan. 19, that person seemed to be Brown.

But as the next 61 days would show, culminating in Sunday night's historic vote, the fate of the legislation ultimately rested in the hands of Obama, who in the hours before Brown's victory was growing increasingly frustrated as Pelosi detailed why no answer was in sight.

There went health-care reform.

There went history.

"I understand that, Nancy," he finally snapped. "What's your solution?"

* * *

Panic. Despair. Back stabbing. Recriminations. Calibrations and recalibrations.

From the evening hours of Jan. 19 to Tuesday's bill-signing ceremony, Washington has been in full soap-opera mode, including the grandiose declarations made since Sunday night.

"Just think," Pelosi said as the House neared its vote, "we will be joining those who have established Social Security, Medicare and now, tonight, health care for all Americans."

Said Obama after the 219-212 vote: "In the end, what this day represents is another stone firmly laid in the foundation of the American dream." He added: "Tonight, we answered the call of history as so many generations of Americans have before us. When faced with crisis, we did not shrink from our challenge -- we overcame it. We did not avoid our responsibility -- we embraced it. We did not fear our future -- we shaped it."

Republicans viewed the action differently.

"With all this euphoria that's going on, this inside-the-Beltway, champagne toasting and all that, outside the Beltway, the American people are very angry," Sen. John McCain (Ariz.) said Monday. "And they don't like it. And they're going to try to repeal this. And we are going to have a very spirited campaign coming up between now and November. And there will be a very heavy price to pay for it."

But the rhetoric only hints at the drama that unfolded behind the scenes in the effort to pass legislation that will extend insurance coverage to 32 million Americans and dramatically alter how health care is provided. This account -- based on exclusive interviews with a dozen lawmakers, lobbyists and high-ranking administration officials -- highlights some of the key moments in the final push, from the chaotic arm-twisting at the end to a futile attempt at bipartisanship that began in the wake of the Jan. 19 meeting.

As Pelosi and Reid left the White House that night, the administration was coming to the conclusion that its fatal mistake had been giving up so much control to Congress. Although the strategy was intended to correct the mistakes President Bill Clinton made in 1993 when his wife's task force wrote a health-care bill in secret, the Obama White House belatedly realized that the months of delay, closed-door negotiations and special deals had tarnished the effort and a president who won office by promising to change the way Washington operates.

And so came the first attempt at a retooled strategy: a commander in chief back in charge. Obama would still need Pelosi and Reid to deliver votes, but this time the White House intended to steer more aggressively.

"In 2010, the president has to look like he is leading the process," communications director Dan Pfeiffer said in a staff meeting. The goal is to "change the narrative" from the horse trading on Capitol Hill to "Obama finally taking charge of health reform."

* * *

On Jan. 29, Obama traveled to Baltimore for a rare appearance with House Republicans. The televised give-and-take showed him at his best, and it gave a psychological boost to his White House team, including his chief of staff, Rahm Emanuel, who proposed that Obama hold a bipartisan summit, much like the successful summit on welfare reform that Clinton had held in 1995.

Obama, who felt particularly stung by critics who said he had broken his pledge to air the health-care debate on television, immediately embraced the summit concept. It would be a chance to reset the effort, display his willingness to accept Republicans' ideas and claim -- albeit more for show than substance -- that he was crafting a "new" bill that was not sullied by the deals struck in Congress.

Privately, some of his key aides had doubts, such as health-care adviser Nancy-Ann DeParle and legislative liaison Phil Schiliro. They felt that they had tried for nearly a year to reach out to a handful of Republicans, with no success. Why give the GOP another opportunity to delay?

But Obama viewed the summit as a fresh chance to sell the public on his vision and highlight what he considered shortcomings in the Republican proposals. At a meeting in the Roosevelt Room shortly after returning from Baltimore, he ridiculed health-care legislation sponsored by House Minority Leader John A. Boehner (R-Ohio).

"Covering 3 million people is not our goal," Obama reminded aides.

Emanuel, who served in the Clinton White House, raised the prospect of scaling back the bill, a theme he had struck several times over the previous year. As the architect of many small-bore initiatives in the Clinton era, Emanuel had periodically argued that it was "better to get points on the scoreboard" with modest legislative success than to have nothing.

After the defeat in Massachusetts, he again asked aides to run the numbers on smaller-scale alternatives -- as a fallback, at least. Most of the scenarios envisioned spending $150 billion to $500 billion over a decade and would focus on coverage for young adults or families with young children.

Obama considered what Emanuel was saying. For days, he had been hearing Pelosi warn that she could not round up the votes for the Senate bill. The speaker was one of the most skilled vote-counters in history; her assessment carried weight.

But Obama knew she was one of history's most skilled vote-getters as well. More than anyone else, in fact, she had been the reason the House passed its health-care bill in November.

The first House tally had been close, with just two votes to spare, and it was headed for defeat until an extraordinary day just before when Pelosi, confronting a major rift over federal funding for abortion, called together the female Democrats in the House and said, "We're standing on the brink of doing something great. I'm not letting anything stand in the way of that."

And she didn't. All day long, she shuttled from one meeting to another in the warren of offices that make up the speaker's suite. In one, she met with the people who could tip the balance on the last few votes she needed: antiabortion lawmakers, as well as lobbyists for Catholic bishops.

In another room were her abortion rights allies. She showed them her tally sheets. "I don't have the final votes for passage," she said. "I don't know what to do."

In reality, she did know what to do, and soon it became clear to her closest friends that she was willing to accept tight abortion limits in the bill, which meant a vote for health-care legislation would mean a vote for restrictions they so loathed.

The women became furious. Voices were raised. Rep. Louise M. Slaughter (D-N.Y.), a close friend of Pelosi's, lamented about "all the women we were just throwing under the bus" and called it "a betrayal of all the women that had fought for this for so long." Pelosi, according to two participants, had tears in her eyes. But she got the votes -- that time.

"Maybe we just can't get there," Obama said now to his advisers. But let's at least try.

"We're so close," he said. Bills have passed the House and Senate. "We're right there. Even if we are within the realm of possibility, we should go for it."

* * *

If Obama was beginning to reassert control behind the scenes, the message was more muddled in public. Although he continued to say he was determined to see lawmakers pass the legislation, he offered scant ideas for how they might do so.

On Capitol Hill, where fears of a wipeout in the November midterm elections were coursing through the Democratic ranks because of the upset in Massachusetts, lawmakers grumbled that Obama was still leaving the hard work to them.

The president decided to meet them halfway -- literally.

On Feb. 3, his limousine made the short ride down Pennsylvania Avenue to the Newseum, the modernist structure just a few blocks from the Capitol. In a televised session with Senate Democrats, Obama delivered a message of solidarity, assuring the beleaguered lawmakers: "I'm there in the arena with you."

He and the press corps left. Another triumph, it seemed. But then the tensions exploded.

Sen. Al Franken (D-Minn.) launched into a tirade against David Axelrod, a senior White House adviser and one of Obama's closest confidants.

"I have been in a slow burn here, a slow burn!" the lawmaker hollered from the last row of the meeting room. "I'm just livid."

Lacing his commentary with profanity, Franken complained that the health-care campaign had been lackluster and leaderless, particularly in the tentative period since Brown's victory.

"Goddamn it, what's the deal here?" he said, as colleagues, their spouses and aides looked on. "You're talking platitudes, and we have to go home and defend ourselves. We're getting the crap kicked out of us!"

Axelrod, a laconic Chicagoan not prone to excitability, catalogued Obama's work over the past year.

"Add up the number of trips, speeches, radio addresses," he said. "I spend a good part of every day with him, and I know that he's still working hard on this issue."

Franken wouldn't relent.

"The president of the United States comes up here, you come here, and none of you are telling us what we're going to do about health care," he continued. "He should apologize to everyone here for his stupid idea during the campaign to put this all on C-SPAN."

To some in the room, Franken's outburst felt like theater from a longtime performer. But others were pleased that the former comedian was giving voice to the months of friction.

"There's a great deal of frustration that the president isn't getting the feelings that a lot of us are feeling," said Sen. Bill Nelson (D-Fla.). "The president needs to be more hands-on with the health-care bill."

"I assure you the president is getting that message," Axelrod replied. "We have a plan."

That prompted Sen. Carl M. Levin (D-Mich.).

"What is it? What exactly is the plan?" the former lawyer asked in a prosecutorial tone. "What is the strategy?"

Axelrod took the verbal punches -- until Franken questioned Obama's commitment to the bill they had spent 12 months selling.

"Al, you can say whatever you want, but don't tell me the president hasn't led on health care," Axelrod said. "This thing would have been dead 15 times before now if he hadn't been persistent and committed. I don't know anybody in my memory who has expended more of his own political capital on an issue than he has on this one."

"Then why doesn't he go over to the House and tell them to pass the Senate bill?" Franken said.

"Al, if you've got 218 votes in your pocket, hand me the list," Axelrod replied. "I will personally walk it over to the speaker and we can take care of this tomorrow. But I don't think she has that list in her pocket."

* * *

Late February. Obama continued his elusive search for bipartisanship.

In so many ways since taking office, he had seemed to be searching for the right balance between two versions of himself: Obama the idealistic community organizer, and Obama the pragmatic president who could abandon core principles in the drive to pass a bill.

His decision to hold the bipartisan summit was based in the belief that he could personally overcome the ferocious partisanship gripping Washington and woo at least a few Republicans -- or at least show he was trying.

It also brought together the two Obamas.

On Feb. 25, the president and 28 lawmakers squeezed around a giant square of tables in the Garden Room of Blair House. After more than seven hours of talking, the members of Congress grabbed their coats and raced for the doors.

Not Obama. He lingered behind, shaking hands, making one last pitch for his stalled initiative. After all the others were gone, he stepped into the brisk darkness and made the short walk across the street to the White House.

"There were some good things that came out of that," he told advisers in the Oval Office afterward. He said he wanted the final legislation to incorporate a handful of ideas Republicans raised during the session.

A few aides protested. Shouldn't they extract a few votes in return? "Let's bargain for these," one said.

Obama -- naively, some would say -- still held out hope for a couple of converts. "We're going to accept some of these," he said.

Over the following weekend, DeParle and other administration officials made overtures to several Republicans. They spoke to Rep. Peter Roskam (Ill.), who served with Obama in the state legislature. They conferred with Rep. John Shadegg (Ariz.) about ways to sell insurance across state lines and with Sen. Tom Coburn (Okla.) about his idea to hire undercover Medicare fraud investigators.

But it was too late. Republicans denounced the summit as an 11th-hour publicity stunt and declared that they would not help pass Obama's health-care bill, even if it did include some of their proposals.

Pelosi, meanwhile, had grown more bullish about her prospects in the House. Though the summit had not won over any Republicans, it had reassured some jittery Democrats that Obama was fully engaged in the fight.

The strategy of coming across as a leader appeared to be working. Heartened, Obama set on what would be the final course of his top domestic initiative.

During an appearance in the East Room on March 3, surrounded by doctors in white lab coats, he outlined a final health-care bill. The substance of his announcement was hardly newsworthy: The Obama proposal was largely the compromise measure negotiated in early January, before the election in Massachusetts, with a few Republican additions.

Far more significant was the strategic decision the president made to pursue a delicate procedural two-step that Emanuel and Deputy Chief of Staff Jim Messina had brought up soon after Brown's Senate victory. Step one: The House would adopt the Senate bill -- the very measure that Pelosi had called a "non-starter." Step two: The House would then approve a batch of changes in a separate budget "reconciliation" bill, which would require only a simple majority of 51 votes in the Senate, not the 60 needed to overcome a filibuster. Even with Brown added to the Republican side, there were still 59 Democrats in the Senate. More than enough.

Democrats, in other words, would go it alone.

* * *

A few hours after his speech in the East Room, Obama threw a party with an ulterior motive.

Under a 19th-century French chandelier, he and a few dozen lawmakers toasted the enactment of a law imposing "pay as you go" budget restrictions. As tuxedoed waiters passed hors d'oeuvres and a bartender poured drinks, Obama, Vice President Biden and a trio of senior advisers worked the room, moving from one clutch of Democratic deficit hawks to another.

The search for votes was on.

In one corner, Biden reminisced about the late congressman John P. Murtha (D-Pa.) with Democratic Reps. Jason Altmire (Pa.), Peter Welch (Vt.) and Lincoln Davis (Tenn.). The president ambled up to the group and praised the lawmakers' support of the legislation, dubbed paygo.

"This is so extraordinarily important for the country. We have to get back in fiscal balance," Obama said. "Paygo is the tool to help us."

But the real reason for the president's schmoozing quickly became evident. Looking toward Welch, an enthusiastic supporter of the health-care overhaul, he said: "And you know what else would help us with the deficit?"

Without missing a beat, Welch turned to Altmire, who voted against the bill in November but was on the fence in March.

"Yes," Welch said, "health-care reform."

Then Obama draped one arm over Altmire's shoulder, turned away from the others and leaned in close to his intended target.

"Peter's right, Jason," Obama said. "We have to do this. It is essential to bringing down the deficit."

Estimates by the independent Congressional Budget Office would soon show that the measure would reduce the deficit, Obama said, while the status quo "blows the deficit."

Altmire, more than most in Congress, understood the intricacies of health policy. As a congressional aide in the 1990s, he had worked on Clinton's failed effort and later became a hospital executive. He opposed the bill in November in part because it would not have gone far enough to control rising medical costs.

Obama saw that as his opening, pointing out to Altmire that the new version would create a Medicare cost-cutting commission.

Altmire reminded Obama that he had been to the congressman's district in western Pennsylvania, a conservative region where Republicans often win and the Roman Catholic bishop holds considerable sway.

"I want to represent my district," he said. "As you know, it is politically split."

As the president drifted toward a lectern to address the entire room, Emanuel cornered Altmire. The two went back to 2006, when Emanuel helped the former high school football star win his seat in Congress.

"Your constituents like you; you've built up a reservoir of goodwill," Emanuel said. "You have an opportunity before this vote to go back home and explain it to them."

Obama and Emanuel had made clear that they needed the votes of many of the lawmakers sipping cocktails that evening, even skeptics such as Altmire.

The conversations in the Blue Room however, were but a gentle hint of what was to come.

* * *

The day after the reception, Obama began his final, most intensive push to corral votes, a round-the-clock effort in which he delved into arcane policy discussions, promised favors, mapped out election strategy and, when all else failed, painted the grim portrait of what a weakened presidency would mean for Democrats and their lofty legislative ambitions.

He hit the road, rolling up his sleeves at boisterous rallies outside Philadelphia, St. Louis and Fairfax. He revived his attacks on the insurance industry, a strategy bolstered by the latest round of double-digit premium increases. His Cabinet members wrote op-ed pieces, while his political operatives coordinated a $7.6 million pro-reform advertising blitz in 40 congressional districts.

But it was the personal touch -- in carefully-tailored appeals -- that mattered the most in the closing days.

Some fence-sitters nearly drowned in presidential attention. The day after the party in the Blue Room, Altmire was back at the White House for a meeting with centrists in the New Democrat Coalition.

"The economy's going to turn around," Obama assured them. With time, he said, "this is going to be viewed as a good vote."

A few lawmakers chimed in to agree, but Rep. Adam Smith (D-Wash.) told Obama that the health-care bill wasn't selling well in some parts of the country. It wasn't simply a matter of "all hold hands and jump off the cliff together," he said, half in jest. "This is going to be difficult."

"If this was easy," the president replied, looking around the Oval Office, "you wouldn't be sitting here."

That same day, Obama faced a group of disappointed liberals, many of them supporters of a single-payer, government-run system. They had such high hopes that he would stick to his promise to create a public insurance option.

"This is a foundation," he told them. "Thirty-one million Americans will be covered under this. It's a beginning."

Most in the room had resigned themselves to the Obama compromise, but Rep. Dennis Kucinich (D-Ohio) refused.

"I'm concerned this is going to create a foundation for the increased privatization of the system," he said from a leather chair under a "Rough Rider" portrait of Theodore Roosevelt. "It's giving $70 billion to industry."

Kucinich left the White House saddened. He'd developed a bond with Obama during the 2008 Democratic presidential primaries and didn't enjoy saying no to his former rival. It appeared they were at an impasse.

The White House had better luck with Rep. Melissa Bean (D-Ill.). After one group meeting, Obama asked her to stay behind.

"Let me talk to my homegirl," he joked. They compared notes on their families -- both have two daughters. Then Obama made a gentle plea: "These reforms are really important."

A few days later, seated at the conference table in his spacious corner office, Emanuel was more direct, reminding Bean of the support he lent in her campaigns and why she came to Washington.

"You ran because you care about the deficit," he said. "This is north of $1 trillion in deficit reduction."

Bean wanted to see the final bill and a cost estimate.

"The Senate bill is stronger than the House bill, and you voted for the House bill," Emanuel countered.

"I'm glad you heard us," she replied.

"Melissa, name me once in the last six years you voted for a bill with more deficit reduction," he said. And, he added, if she opposed the health-care legislation, "don't ever send me another press release about deficit reduction" over 20 years.

On Monday, March 15, Obama began what aides hoped would be the final week in their year-long march. On the flight to a rally in Strongsville, Ohio, Obama rode in his private cabin with Kucinich.

Seated across a small table with a laptop beside him, Obama ticked off a litany of groundbreaking legislative achievements -- all of which, he argued, began small. Medicare, he said. Civil rights.

They hashed through the substance; Obama spoke about the tens of millions of uninsured Americans who would be covered under the bill. It was cordial, but they were still at loggerheads.

Finally, the president recalled that it was Kucinich, during the Iowa caucuses, who directed his delegates to back Obama on a second ballot. "Dennis, you were the only candidate to do that," he said.

Now, Obama said, his presidency was on the line. This wasn't about him, "but about our ability to get anything done."

On Capitol Hill, Pelosi was once again methodically working down her tally sheet, counting names in the hunt for the 216 votes she would need to deliver for Obama once again. She received a pleasant surprise on Wednesday, when Kucinich announced he had changed his position.

Kucinich's support was more than just one vote in the "yes" column; it was the start of the momentum the White House had been struggling to create.

In short order, the news rolled out in a steady, well-choreographed clip.

"Gordon, Markey, join no-to-yes" contingent, one announcement said. "Boccieri switches to yes." At the White House, confident aides stole time to watch the NCAA basketball tournament.

Obama, meanwhile, doused a brush fire with organized labor over changes to a new excise tax that unions did not like. In a chance encounter in an aide's office that was actually well planned out, Obama pulled AFL-CIO President Richard Trumka into the Oval Office.

"We're at the one-yard line. We've just got to get the ball in the end zone," the president said, imploring Trumka to hold his complaints for another day. "Rich, you've got to stay with me."

But not everything went their way, and Pelosi and Obama sweated into the weekend.

On Friday morning, Altmire e-mailed Emanuel. Despite the party on St. Patrick's Day at the White House, a sit-down with Emanuel, a few more phone calls from the president and three from Cabinet-level officials, Altmire planned to announce that he would vote no.

"Don't do it," Emanuel punched back on his BlackBerry. At 4 p.m., Altmire released his statement and at 7:30 Obama called once more.

"I want to give you something to think about before the vote," the president said gently into the phone. "Picture yourself on Monday morning. You wake up and look at the paper. It's the greatest thing Congress has done in 50 years. And you were on the wrong team."

Saturday. Two days left, and it was time for the closing strategy. Arm twist after arm twist, deal after deal, these last days played out so publicly that at some point amid the news conferences and speeches it started to feel like a compressed, frenetic rehash of the 14-month fight.

Protesters on the Capitol lawn. Rumors of enticements -- a Cabinet post, water access in California, money for NASA. More phone calls, more news conferences, frayed nerves, exhaustion.

At the Capitol, Pelosi was once again dealing with the specter of abortion funding, shuttling from office to office as she locked down the final votes. Not once, but twice, she had done what no other speaker could accomplish.

And Obama, once again, was ensconced in the White House contemplating the fate of his signature domestic initiative, a scene so familiar that it could have been Jan. 19 all over again. Would the House adopt the Senate bill?

But this time, instead of panic, instead of sniping and interrupting, there was, at the end, a win.

Here came health-care reform.

Here came history.

Staff researcher Alice Crites contributed to this report.

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