Why did health-care reform pass? Nancy Pelosi was in charge.

By Vince Bzdek
Sunday, March 28, 2010

Congress had tried to hammer together a national health-care initiative for a century, but it wasn't until a woman ascended to a key position of power in Washington that a plan actually passed.

This is not a mere historical coincidence. Sure, President Obama pushed health-care reform to the top of the country's agenda, and the Democratic majorities in the House and the Senate were essential to passing the bill. But make no mistake: The overhaul happened because Nancy Pelosi wanted it to happen, deep in her DNA.

This wasn't just another piece of legislation for Pelosi -- this was the culmination of a crusade she has been waging her entire career to reorder Washington's priorities. Pelosi's animating ambition has been to put so-called women's and family issues such as health care, education and the welfare of children on the same level as homeland security, foreign relations and defense.

The tenacity with which she fought for health-care reform is directly tied to her gender. The belief that women, and the agendas they tend to support, are underrepresented has provided much of the rocket fuel that propelled her rise through Congress over 22 years. In 1984, Pelosi ran for the Democratic Party's national chairmanship and lost; party leaders told her she would have won if she had been a man. Since then, the Californian has been on a mission to smash the old-boy network in Washington.

When Pelosi made expanding health care one of her top priorities, friends and colleagues say it was, without question, because she is a woman and a mother.

"It's personal for women," Pelosi announced on the House floor during final arguments on the health-care bill March 21. In an interview the next day, she said, "My sisters here in the Congress, this was a big issue for us."

Pelosi said her fellow "caregivers" had a lot invested in reform, since they are the ones who provide most of the health care for their families and are acutely aware of problems in the system.

And on the House floor, she said, "After we pass this bill, being a woman will no longer be a preexisting medical condition." In a recent roundtable discussion, Pelosi explained that insurance companies charge women higher premiums than men by "gender rating" conditions such as giving birth, having a C-section or being a victim of domestic violence. These "preexisting conditions" also allowed the companies to refuse coverage; they can't do that anymore.

Because improving health care was a sacred cause to Pelosi, she had the backbone to stick with it at critical points along the way. After Republican Scott Brown won Ted Kennedy's old Senate seat from Massachusetts with a promise to thwart the health-care bill, Pelosi was the only leader who didn't blink. According to published reports, when President Obama was contemplating a compromise with Republicans, and White House Chief of Staff Rahm Emanuel and Senate Majority Leader Harry Reid (D-Nev.) were advocating a less-ambitious measure (which Pelosi derided as "kiddie-care,") she persuaded them to stick with an omnibus bill.

When other congressional leaders and the White House were scrambling for votes in the final days of debate, and Rep. Bart Stupak (D-Mich.) demanded a ban on public funding for abortions in exchange for his support, Pelosi stood firm. She promised that there would be no health-care bill if it included the Stupak language. Instead, Obama issued a presidential order affirming the existing prohibition on federal abortion funding.

And it was Pelosi who personally rounded up votes time and again, keeping her Democratic caucus unified enough to get more than the 216 ayes she needed.

Passing such a controversial law required raw political savvy. And Pelosi learned much of it managing the "favor file" for her father, Thomas D'Alesandro Jr., the longtime mayor of Baltimore, and during years of rough-and-tumble politics that had nothing to do with gender. But even Pelosi believes her vote-gathering and coalition-building skills represent a new, more collaborative way of doing business in Congress.

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