Updated, 6:40 p.m. | Jacob S. Hacker, a political science professor at Yale, joins the discussion.
The House leadership is now engaged in the art of procedural jujitsu in hopes of winning 216 votes to approve the Senate health bill and push through the most expansive health care overhaul since the creation of Medicare.
Efforts over four decades have gone down to defeat. Will health legislation pass this time? We asked some political observers for an assessment of the forces that are driving this effort to a conclusion.
- Robert Reich, former secretary of labor
- Gail Wilensky, Project Hope
- Paul Starr, professor of public policy
- James C. Capretta, Ethics and Public Policy Center
- Karen Davenport, Center for American Progress
- Jacob S. Hacker, political science professor
Getting to Yes
Robert Reich, a professor at the Goldman School of Public Policy at the University of California at Berkeley, was secretary of labor in the Clinton administration. He is the author, most recently, of “Supercapitalism,” and he blogs at Robert Reich’s Blog.
I’m beginning to think President Obama has the votes. Two hundred House Democrats are definitely on board. To get a majority, he needs just 16 more out of the 53 remaining (it’s safe to assume no House Republicans are with him). Here’s where I see the 16 coming from:
Here’s how the final 16 votes Obama needs will shake out.
– At least three Blue Dogs from fiscally conservative districts. They voted against the original House bill because it cost too much but will finally sign on to the Senate bill because it costs less.
– No fewer than three liberals from left-of-center districts. They threatened to vote no because the Senate bill doesn’t contain a public option, but will vote yes because they decide giving 31 million more Americans health insurance is better than nothing.
Making Deals Everywhere
Gail Wilensky is a senior fellow at Project HOPE. She was the administrator of Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) from 1990 to 1992 and the chairwoman of the Medicare Payment Advisory Commission from 1997 to 2001.
After so many wrong predictions on health care reform, I hesitate to make one more but as of today, I think the legislation will squeak through the House.
The bill will pass, worsening the public’s view of Congress and sharpening the partisan divide.
With a 77 vote majority and with no limit on what the White House and leadership will offer (or threaten) to get the necessary votes, it is hard for me to imagine that they won’t be able to get the 216 votes they need — although they obviously don’t have them as of today. Otherwise, they would have already voted.
At least three groups of Democrats in the House are hesitant to support the Senate bill. Hispanic law-makers concerned that illegal immigrants won’t be able to purchase insurance in the exchange using their own funds, fiscal conservatives who worry the legislation does too little to control spending and abortion opponents who fear the Senate language won’t prevent public funding of abortions.
Taking on History
Paul Starr, a professor of sociology and public affairs at Princeton, is the author of ”The Social Transformation of American Medicine.” He was a senior health policy adviser in the Clinton administration.
History is littered with foolish expressions of confidence in the likelihood that health-care reform will pass. One more will hardly be noticed.
Democrats from conservative districts are the ones most likely to get wiped out if inaction on health care brings on a Republican tide.
Moral commitments and political imperatives are together driving the Democratic Party to pass health-care reform. If this were not a not a deeply felt cause, the president and congressional leaders would not have risked so much on it in the first place. At crucial junctures when defeat seemed likely, they pressed forward and now, having staked their fortunes on the legislation, they cannot turn back: it has become a test of their ability to govern.
And so Democrats in Congress find themselves facing an uncomfortable but clear choice. Although they may not reap political advantage from the legislation, most of them recognize that failing to pass it would be worse. The devastating aftermath of their party’s inability to act on health care in 1994 remains a vivid, cautionary lesson.
Voters Aren’t Naïve
James C. Capretta, an associate director at the Office of Management and Budget from 2001 to 2004, is a fellow at the Ethics and Public Policy Center.
The only reason the health bill is still under consideration at all is that Barack Obama has more or less staked his presidency on passage of it. Many rank-and-file House Democrats would have walked away long ago if their party leaders had allowed them to do so.
Despite enormous pressure from the White House, the odds are still against passage.
But the president has decided that the only way to get a bill to his desk is by making defeat unfathomable for members of his own party. If the health bill were to go down to defeat, there’s no doubt that he would be seriously weakened. It is likely that some House Democrats will support passage simply because they don’t want to be responsible for dealing such a crippling blow to the administration.
Still, despite the enormous pressure from the White House, the odds remain against passage, Democratic catastrophe and all.
Too Late to Turn Back Now
Karen Davenport is the director of health policy at the Center for American Progress and served on the White House Health Care Reform Task Force in 1993.
There are people who are very good at counting votes, but I’m not one of them. Still, I think health care reform will pass the House this week.
Voters will disdain lawmakers who fail to follow through or vote no after they vote yes.
A modified version of the Senate health reform bill will emerge from the House and the Senate for several reasons. First, the cost of doing nothing — of continuing on the path we’re on, with coverage disappearing and employers, individuals and families facing ever-higher health care bills — is simply too high.
As hard as it can be to move major legislation, members of Congress understand that the choice isn’t between change and the health system as we know it. The current system will become more expensive, leave more people uninsured, and pose a greater threat to the economy if nothing is done.
It Must Pass
Jacob S. Hacker is a professor of political science at Yale and the author of “The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream.”
I believe health care legislation is going to pass. But the better question is: Should it pass? And the answer to that question is easy: Yes. The congressional vote should not be anywhere near as close as it will be.
Saying no to the current legislation is saying no to health security for a long time to come.
Think of the health bill as the admission of a patient to a hospital for a first round of treatment. It won’t cure all, but it will begin addressing problems that have gone untreated for far too long. It will make coverage both more affordable and more accessible, greatly restrict what insurance companies can do to deny care or avoid patients who need it, and substantially reduce the federal budget deficit. More will be needed in the future, including the public health insurance option that I have long championed. But the treatment must begin now.