Outside Capitol Hill, conservative protesters had declared “No socialistic health care” and chanted “Kill the bill.” But the real obstacles to President Barack Obama’s effort to pass health care reform legislation this year have been divisions among his fellow Democrats. The bill that narrowly passed in the House of Representatives last weekend came at a high price for many liberal Democrats: among other things, it included broad restrictions on abortion funding in order to win over the votes of conservative Democrats, without whom the bill would not have passed. Now, as the Senate prepares to debate its own health care bill, which would eventually have to be reconciled with the House version, any final product is expected to be even more conservative—again, thanks to Democrats.
Included in the House bill was a so-called “public option”—a government-run not-for-profit insurance plan intended to compete with private insurers to provide Americans with a lower-cost option. The provision, which Republicans decry as a “government takeover of health care,” is already a far cry from the Canadian-style government-administered single-payer system many liberal Democrats wanted. But a crucial handful of conservative Democrats in the Senate are skeptical of the public option, and may torpedo such a provision—opening a potentially bitter ideological divide within the Democratic party.
While passing the abortion funding restrictions and watering down or eliminating the public option may help Obama achieve his long-awaited health care reform, activists among the liberal Democratic base are already warning that donations, volunteers, and door-knockers in advance of next fall’s mid-term election will be harder to come by if such legislation passes. And the Democrats, who enjoy a traditional edge among women voters, could feel the wrath of pro-choice women. Already, some grassroots Democrats activists are vowing to eat their own. The liberal group Moveon.org is collecting pledges from supporters to help fund challengers to any Democratic senator who votes against the health care bill, and has amassed US$3.5 million so far. Another liberal group, Democracy for America, is calling on any Democrats who oppose the public option to be stripped of their committee chairmanships. Another liberal group, the Progressive Campaign Change Committee, is targeting ads at Democrats who voted against the bill, declaring, “It’s payback time.”
It might seem natural that Democrats would want to hand Obama a major legislative victory on the signature issue of his first term. But when Speaker Nancy Pelosi set a deadline of last Saturday to pass the reform bill through the House, she didn’t know if she’d have the votes to succeed. Even after the 11th-hour abortion compromise, 39 Democrats still voted against the bill, which squeaked through with a vote of 220 to 215. Two Democrats voted against it because it wasn’t liberal enough, but the other dissidents said it was too liberal. For example, 24 of those who voted “no” were so-called conservative “Blue Dog” Democrats, concerned that the overall reform package would prove too expensive. As well, 14 of the naysayers were first-term representatives from competitive districts worried about losing their seats to Republicans. Indeed, a total of 31 of the 39 “no” voters were Democrats in districts that in 2008 were carried by Republican presidential candidate John McCain. Now, with unemployment in double digits and an anti-incumbent mood prevailing in the country, they are treading carefully. “This is a very, very controversial bill,” says Larry Sabato, a congressional analyst at the University of Virginia. “In more conservative areas it will hurt Democrats who voted for the bill. Some will lose on account of it. To the extent possible, [the House leadership] wanted to allow those Blue Dogs to vote no.”
It didn’t help matters that the vote took place in the wake of the Nov. 3 off-year elections that ushered in Republican governors in New Jersey, a Democratic stronghold, and in Virginia, where Obama had made inroads for Democrats last year. That result was a warning shot heard by Democrats from conservative districts around the country—and demonstrated that Obama-mania is giving way to public frustration with unemployment, the growth of government and mounting deficits. With that hostile backdrop, many moderate and conservative Democrats have been reticent to embrace an ambitious health care bill.
Another major stumbling block in the House bill was abortion. For 30 years, U.S. law has prohibited government funds from subsidizing abortions. The House bill did the same, but opponents of abortion said it did not go far enough because it allowed private insurance plans that cover abortions (as more than half do) to also accept government subsidies to start insuring low-income Americans. Although the subsidies were not supposed to cover abortion, critics said the approach was merely an accounting gimmick. After tense haggling, the final bill included language that would bar any insurance plan that receives federally subsidized clients from covering abortion services. Pro-choice groups were outraged. “It is unconscionable that anti-choice lawmakers would use health reform to attack women’s health and privacy, but that’s exactly what happened on the House floor tonight,” said Nancy Keenan, president of NARAL Pro-Choice America.
Of course, even in its most conservative incarnation, the health care legislation would mark a huge reform in U.S. health care. Major changes include rules prohibiting insurance companies from refusing to cover individuals with “pre-existing conditions,” and government subsidies for tens of millions of uninsured Americans to buy health care plans. The legislation also contains a variety of measures aimed at reducing health care costs. The House version would pay for the subsidies by raising taxes on the highest income earners, while the Senate has contemplated imposing new taxes on the most expensive health care plans.
The action now moves to the Senate, where the possibilities for passage are even more daunting. Senate majority leader Harry Reid is expected to introduce legislation for debate later in the coming week that will merge bills passed earlier by two Senate committees. While Democrats hold 58 of the 100 seats, they need 60 votes to overcome Republican procedural manoeuvrings that could kill a bill. And at least five Democratic senators cannot be counted on to support a bill that includes a public option. There is Nebraskan Ben Nelson, who said on Tuesday that he wants to see abortion restrictions in the final bill and also stated he “can’t support a government-run health plan that would undermine the 200 million Americans who have private health insurance.” There are non-committal senators Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana, who represent conservative states. Similarly, senators Evan Bayh of Indiana and Kent Conrad of North Dakota have expressed concerns about the costs of a bill.
The one possible Republican vote could come from Maine Sen. Olympia Snowe, who has proposed a “trigger” version of the public option: if private insurers would not provide sufficient competition to consumers, a public option could be “triggered.” Many liberal Democrats consider this an unacceptable “watering down” of the public option. Adding to the uncertainty are two unpredictable independent senators. Joe Lieberman of Connecticut, who was Al Gore’s vice-presidential running mate in 2000 before later leaving the Democrats after losing a Democratic primary campaign, has said he will help a Republican filibuster against any bill that includes a public option. “If the public option plan is in there, as a matter of conscience, I will not allow this bill to come to a final vote,” he has said. “Because I believe the debt can break America and send us into a recession that’s worse than the one we’re fighting our way out of today. I don’t want to do that to our children and grandchildren.”
Meanwhile, the Senate’s other independent, Bernie Sanders of Vermont, who describes himself as a “democratic socialist,” has not committed to supporting the legislation either. Sanders wants a single-payer system like Canada’s, and has declined to say whether he will support the Democratic bill, especially if it includes a weak version or no version at all of the public option. “All I’ll say for now is that I want the strongest public option possible in the bill,” Sanders told The Hill newspaper after the House vote. “Beyond that, we’re going to have to look at what develops.” Similarly, Roland Burris, the Democratic Illinois senator appointed by disgraced governor Rod Blagojevich, has said he will vote against a bill that does not include a public option.
Meanwhile, the White House will keep pushing for any compromise that will cover the uninsured, not add to the deficit, and help ailing Americans obtain or keep their coverage. Obama has said he wants the abortion provision removed, but ultimately, he has to take whatever he can get through the Senate. “He has to have a bill. His first term will not be a success with a bill,” says Sabato. “He will take a piece of the pie. He won’t get the whole pie.”