I don’t think anyone believes that yesterday’s passage of the motion to proceed on health care reform presages passage of the overall bill in the Senate. Practically moments after yesterday’s vote and even before, every Democrat who wants leverage over the bill scrawled their ransom notes and made public their demands. Many of them received perks of one sort or another to get on the motion to proceed, although I cannot get too worked up about Mary Landrieu getting $300 million in Medicaid increases for her state – indeed, in the wake of Katrina, poor citizens have legitimate needs and should get a boost in Medicaid spending.

Without claiming to be holdouts on the bill, conservatives like Ben Nelson, Joe Lieberman, Mary Landrieu and Blanche Lincoln would have no ability to receive such sweeteners. So this is part of the process, and it’s worth noting that others like Mark Warner, Jim Webb and even Bernie Sanders are making similar noises, that their votes are not guaranteed and that they must be placated to vote for the bill in the end.

We’re starting to see some of the lists of demands. Ben Nelson offered one today:

Sen. Ben Nelson (D-Neb.), who is uncommitted moving forward, said he has delivered two pages of proposed changes to Majority Leader Harry Reid.

“There is not a lot of explanation there. These are just items,” Nelson said.

What’s on it? Public option, abortion, and CLASS Act, among other things.

“There will be a lot of discussion back and forth about what might get enough votes,” Nelson said after the vote. “There will have to be fairly significant changes for others as well, not just me.”

Nelson’s opposition to the CLASS Act is particularly galling. This is a program that actually reduces the deficit in the first decade, and provides a bare-bones benefit, completely voluntary, of assisted living services, reducing the need for expensive nursing homes that eventually hit state and federal budgets on the back end. It will help millions of Americans to die with some facsimile of dignity, but because the insurance would be federally provided instead of through an insurance company like the one Nelson ran before becoming a politician, he can’t abide it.

The CLASS Act is a small stumbling block, however, compared to the public option, which Nelson explicitly tied to the abortion provision earlier this week. Lieberman, Landrieu and Lincoln have all now threatened to blow up the bill over the measure, even while Lincoln claimed yesterday that “the public option as a part of health insurance reform has attracted far more attention than it deserves.” So this practically meaningless piece of the bill is so tiny and unimportant, she’ll kill it if it stays.

Landrieu and Lincoln previously signed a statement of support for a public option, but again, they have to take a stand to get some concession in the bill, no matter the inconsistency.

Harry Reid now has a needle to thread on health care. Keep the public option, and risk losing conservative Democratic support. Remove the public option, or add a trigger like what Olympia Snowe covets, and risk losing progressive Democrats like Sherrod Brown:

“In the end, I don’t want four Democratic senators dictating to the other 56 of us and to the country, when the public option
has this much support, that it is not going to be in it,” Brown said on CNN’s “State of the Union” the morning after the Senate moved forward on its first procedural motion on the bill. “They will have their chance to [get what they want] in the amendment process.”

Of course, there’s a third option, and that’s reconciliation, requiring only 50 votes (and it could be done solely for the public option, which is a deficit reducer and would seem to qualify), but that has been taken off the table for some reason.

In the House, there are even more pitfalls. Progressives would not need 40 Democrats to kill any bill. There are at least 25 conservative Democrats who aren’t voting for health care if it gave everyone in their districts a million dollars and a pony, and then you have various other members who may be angered about the abortion provision or immigrant restrictions on the exchange or whatever, enough to vote against it. The bloc of progressives necessary to kill a bill is probably closer to a dozen or less, and that would come from members who went so far out on a limb for the public option during this debate, that voting for a bill without one would trigger primary challenges and the end of many of their careers.

A bill is by no means sealed, and it’s going to be a delicate process to find 60 and 218, given that reconciliation is off the table.

Tags: , , , , , , , , , ,