Pelosi's Deal-Making Skills Helped Save Health Care Bill

Whatever one thinks of the substance, and whatever happens from now on, the House Democrats' victory Saturday on their health care reform package with only a single Republican supporter was a triumph of legislative maneuvering, with the biggest kudos going to Speaker Nancy Pelosi (D-Calif.). Any student of the legislative process had to admire and acknowledge the artistry of threading several needles at once to get that minimum winning coalition together.

Pelosi, despite a cushion of 40 votes on paper, faced a daunting set of obstacles. One was the timing: Coming right after an election where Democrats faced setbacks in two high-profile gubernatorial elections, the level of nervousness was especially high among vulnerable freshmen elected in previously Republican districts and among veterans from conservative areas.

Of course, this is just one big battle in a long and difficult war.

Beyond election jitters, the divisions in the Democratic ranks were many, over issues such as abortion, illegal immigration, the public insurance option and the cost of the program. Each could have fractured an already fragile Democratic coalition. Failure to resolve the abortion controversy could alone have meant the loss of up to 40 anti-abortion-rights Democrats; the resolution could have meant 40 or more Democrats who support abortion rights walking away from the bill. The illegal immigration issue could have lost dozens of votes from antsy freshmen and from Blue Dogs--or the defection of dozens on the other side, including 20 Hispanics.

Instead, the indefatigable efforts of Pelosi, along with Majority Leader Steny Hoyer (D-Md.) and other members of the leadership, and Reps. Henry Waxman (D-Calif.), George Miller (D-Calif.) and Charlie Rangel (D-N.Y.), the key committee chairmen, kept just enough Members inside the tent.

Some critics will pooh-pooh the vote, saying Democrats limped by with only one vote of their own to spare. In fact, Pelosi made sure that she did not require any more of her Members than absolutely necessary to cast tough votes on an explosive issue. Her flexibility to cut it that close was assisted by her ability earlier to get several Republican votes for the even more difficult climate change vote, enabling her to release seven Democrats on that issue who would have been in double jeopardy otherwise when the health care vote came up.

Of course, this is just one big battle in a long and difficult war. As I watched the debate and votes Saturday night, I actually thought of "The Lord of the Rings"; a long and bloody battle against the Orcs would leave Gandalf, et al., exhausted--but they would have to pick themselves up and go on to an even longer and bloodier battle against even more formidable odds.

One challenge is that the abortion bridge built to get this bill through the House remains exceedingly fragile. It will almost certainly be changed in a conference; will the eventual compromise, probably along the lines of the one proposed commendably and courageously by Rep. Brad Ellsworth (D-Ind.), be enough to keep the House coalition together? Or if the amendment sponsored by Rep. Bart Stupak (D-Mich.) remains in the ultimate bill, constraining abortion insurance protection even more than current law, will it cause a sizable number of lawmakers who strongly support abortion rights to walk away from the bill?

Another is that the financing in the House bill, designed to mollify unions and others, took out the one provision that almost all economists say is the best way to bend the cost curve, namely, taxing in some fashion the higher-end health insurance plans. If the conference report puts some kind of levy on such plans, will it shatter the House coalition?

Then there is the illegal immigration question. The Senate and White House caved on this one a while back--shamefully, in my judgment. Six million or more illegal immigrants will be unable to buy insurance on the exchanges even without any subsidy. Imagine, then, that an illegal immigrant gets tuberculosis or some other potent and deadly communicable disease--without insurance, he will probably remain untreated and out there infecting a lot more people. This is totally shortsighted and counterproductive public policy, done in knee-jerk response to nativist pressures from know-nothings. For Democrats, joining the anti-immigrant camp is also folly politically: If Republicans cannot win some significant foothold among Hispanic voters, they will be consigned to minority party status for the long run. But the odds are this foolish provision will stay in the final bill.

The spotlight and pressure now turn to Majority Leader Harry Reid (D-Nev.) and his colleagues in the Senate; needing 60 votes at least to overcome cloture, and with no slack, they have a lot of work to do.

But their work is nothing compared to the daunting task facing Reps. Virginia Foxx (R-N.C.) and Cathy McMorris Rodgers (R-Wash.). Foxx kicked it off with her comments on the House floor that America has "more to fear from the potential of [the House Democrats' health care reform bill] passing than we do from any terrorist right now in any country." McMorris Rodgers--not a backbencher, but a key member of the Republican leadership--then compared the Democrats' bill to an internal terrorist attack.

What a burden they now have! After all, the American Medical Association, AARP, the Consumers Union and the AFL-CIO endorsed a plan that is apparently a blueprint for terrorists. So Foxx and McMorris Rodgers now have to find a way to keep the prison at Guantánamo Bay, Cuba, open longer and to expand it sufficiently to hold thousands of doctors, oldsters and subscribers of Consumer Reports for aiding and abetting the enemy. It may even take a tax increase to fund it. One has to sympathize with their patriotic plight.

Norman J. Ornstein is a resident scholar at AEI.

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