The Health Care Bill's Prospects

Will the health care reform bill pass? Nate Silver, the expert number-cruncher at, thinks it is a 50-50 proposition. The real test will be in the House, and not the Senate, where 51 votes are likely there for a reconciliation package (though so far, only 47 Senators have committed to supporting it).  

The House passed its version of health care reform by 220-215 in late 2009. Since that date, Congressman John Murtha has died, and two other Democrats -- Neil Abercrombie and Robert Wexler -- have resigned. All three voted for the bill. Democratic Congressman Bart Stupak says he will shift his vote from yes to no due to the looser abortion language in the Senate version of the bill as compared to the more restrictive House language. That is also the case with Joseph Cao, the one Republican who backed the bill its first time through.

Factor in these shifts, and for the moment, there are 215 votes for, and 217 against. Stupak claims that there are an additional eleven Democrats who will join him in switching from yes to no if the abortion language does not mirror the original House version, but he has provided no names. Congressman Arcuri from New York, another yes vote, is also wavering. All this would suggest rough waters for passage.  

However, if Stupak has far fewer than eleven lining up with him, then Pelosi may need to switch only a handful of those who voted no the first time to gain passage. No one knows how many of the 39 Democratic no votes for the original House bill were given permission to vote no by Pelosi since she had enough for passage (to protect their electoral prospects) but were actually committed to vote for it if Pelosi needed the votes to reach 218. Now, with the resignation of Rep. Eric Massa, only 216 votes are needed for passage.

Four of the no votes were from blue dog Democrats who have announced their retirement in the last few weeks and no longer face a voter backlash if they switch to yes. These are likely the easiest of the 39 to turn. If the language of the bill changes to please Stupak on abortion, then it is possible that some ardently pro-choice liberals in the House will bolt in protest. The left in the House Democratic caucus accepted the Stupak amendment the first time through, expecting that the Senate version would get rid of it, as it did. It is ironic, to say the least, that the fate of the progressives' dream of a huge new middle-class health care entitlement is at risk due to pro-life members of the Democratic Party. 

The national sentiment on the bill remains quite negative, and most Americans would prefer a smaller, more bipartisan effort (i.e., start over).  

The hard-left dinosaurs who run the Democratic Party in Congress never had any interest in anything other than ramming their version of the bill through with the big majorities they won in 2008. Now the same Democrats who berated the GOP for reconciliation efforts in the past (for much smaller pieces of legislation) are fine with making over a sixth of the country's economy with this technique. So much for the new, post-partisan Obama presidency. 

In any case, while the bill, if it passes, will expand access, it is a nonstarter in terms of cost control. In other words, with a system that is out of control on the cost side, you will be adding well over $2 trillion in spending over the first ten years the program is in effect and making no changes that might slow down the inflation rate (bending the cost curve) to the structure of the delivery system. Massachusetts is the closest model on a state level to the Obamacare plan. That state now has by far the highest insurance premiums in the country.

So will the bill pass? If Stupak has near a dozen votes, and the abortion language is not modified to satisfy him, then the bill will go down. If he has only a handful of pro-life Democrats with him, then Pelosi and the White House will find the bribes and the pressure points needed to get the votes they require for passage, the public be damned.

Jennifer Rubin has a new article posted today making same point I made: that Stupak and his group are the key. She also raises the point that changing abortion language may not qualify as a reconciliation measure (budgetary items only), which means you would have to go to a conference committee to negotiate a new bill, then back to both Houses with 60 votes needed in Senate.  

I am not so sure; if federal funding of abortion is provided in the Senate bill, then it seems to me that  reconciliation can handle it. And it will be Biden who will be ultimate parliamentarian in the Senate.

She make another point which I think is accurate: many blue dogs may be hoping Stupak kills the bill, since they really do not want to go on record voting yes.

I think the situation is very fluid. Polls matter; after a brief rally, Obama numbers are sinking again (today in Rasmussen, 25-42 among those who strongly approve or disapprove, and 45-54 overall).  I also think Stupak wants to win on abortion language but not kill the bill. So he is working with Pelosi and Obama.