I had to check out before the final vote, but last night at 11pm ET, the House of Representatives, for the first time ever, passed health care reform by the skin of their teeth, by the narrow score of 220-215. 39 Democrats voted against, 1 Republican voted in favor. That would be Joseph “TheFuture Is” Cao, who won’t be a Congressman next year, having won a seat over Dollar Bill Jefferson in 2008 in a massively Democratic district.

We’ll look at the final Democratic totals in a second. But let’s just take a step back. It’s been arguably a century since the US has started talking about reforming the health care system; certainly Democrats started running on it in earnest by 1948 and the Truman Administration. This is the first time it’s passed even one House of Congress. It would cover 36 million Americans who previously did not have health insurance, and would pay for that through ending waste and subsidies in Medicare, sharing sacrifice among all stakeholders, and responsibly raising revenue on those who can most afford it. It even includes a public option to compete with private insurance companies, one that Jacob Hacker, the godfather of the public option, deems worth it, despite the use of negotiated provider rates instead of Medicare rates.

But this came at a huge price. In the name of what anyone would agree is an incremental health reform (and entrenched powers in this country leave little opportunity for reform in anything but an incremental fashion, sadly), women’s reproductive rights were set back further than at any time in the last generation, with the passage of the Stupak amendment, a brazen introduction of the anti-choice movement into private insurance markets. Under this standard, any insurance company offering plans on the exchange, be they public or private, would effectively have to deny coverage of elective abortion services. The exchanges are set to grow to emcompass practically all companies, large or small, and maybe all individuals, so you’re basically talking about, over time, banning insurance coverage of abortion. This puts a massive restriction on access to anyone who doesn’t have the funds. Jon Walker explains further.

64 members of the Democratic caucus voted in favor of the Stupak Amendment. 62 were men (of course, Marcy Kaptur and Kathy Dahlkemper were foregrounded in the debate, but no women joined them). Of the 64, 41 ended up going ahead and voting for the bill. But 23 members voted for Stupak, to restrict choice, and then against the health care reform bill. These 23 are simply moles inside the caucus, opposing key planks of the Democratic platform. What’s more, they will have giant targets on their back, both from Democratic activists seeking primaries and Republicans who know that their base will turn out in much stronger numbers for their candidates than these so-called Democrats who appear to stand for nothing. Those names:

Altmire (PA), Barrow (GA), Boccieri (OH), Boren (OK), Bright (AL), Chandler (KY), Childers (MS), Davis (AL), Davis (TN), Gordon (TN), Griffith (AL), Holden (PA), Marshall (GA), Matheson (UT), McIntyre (NC), Melancon (LA), Peterson (MN), Ross (AR), Shuler (NC), Skelton (MO), Tanner (TN), Taylor (MS), Teague (NM)

I don’t know any Democrat who would actually miss any of them.

Artur Davis is running for Governor of Alabama and obviously thinks he has to vote that way to win. His district is extremely Democratic and mostly African-American. It’s vital to get a real Democrat in that seat. Charlie Melancon is running for Senate in Louisiana. David Vitter should breathe easier today because Melancon won’t get one dime from any national Democrat worth his or her salt.

As for the rest of the pro-life Democrats, the fact that 64 would vote that way is a bit shocking. I knew there was a pro-life majority in Congress, but not quite that large of one. Clearly the House leadership didn’t whip the vote at all, allowing everyone who wanted to take a vote against choice, presumably to help them back home. Any Sullivan says that the leadership didn’t address the Stupak caucus’ concerns until it was too late, losing their leverage. But I’m not convinced that Stupak ever had the votes to kill the bill, although clearly the leadership bungled what could have been a better compromise earlier.

There were 39 total Democratic votes against health care, the above 23 plus 16 more (Full roll call here). The New York Times has a nice chart about them and their districts. Lots of these members ran unopposed or won by over 20 points. Eight came from districts Obama won last November. The total 39:

Adler (NJ), Altmire (PA), Baird (WA), Barrow (GA), Boccieri (OH), Boren (OK), Boucher (VA), Boyd (FL), Bright (AL), Chandler (KY), Childers (MS), Davis (AL), Davis (TN), Edwards (TX), Gordon (TN), Griffith (AL), Herseth Sandlin (SD), Holden (PA), Kissell (NC), Kosmas (FL), Kratovil (MD), Kucinich (OH), Markey (CO), Marshall (GA), Massa (NY), Matheson (UT), McIntyre (NC), McMahon (NY), Melancon (LA), Minnick (ID), Murphy (NY), Nye (VA), Peterson (MN), Ross (AR), Shuler (NC), Skelton (MO), Tanner (TN), Taylor (MS), Teague (NM)

Only one, Dennis Kucinich (arguably Massa but I’ve said my peace on that), voted against the bill from a liberal perspective. His statement is here.

Clearly the Democrats allowed exactly everyone uncomfortable with the bill to let themselves go on the vote. They didn’t expect Cao, so they got one above the total needed so nobody could be called “the deciding vote” for health care. Of my final 32 undecideds, they held 24 of them, including Blue Dog votes like Chris Carney, Jim Costa, Zack Space, and Dennis Cardoza.

The White House released a statement of praise.

I’ll have lots more to say on all this later. I think the price of passage was extremely steep, and should not be tolerated. If Barack Obama indeed said he would work to take this language out in conference he should be held to that.