Just When You Thought It Was Safe: 3 Potential Obstacles to Health-Care Reform

It was high drama for a Saturday in the U.S. Capitol Building -- at least what counts for high drama in the Senate. Would Majority Leader Harry Reid be able to deliver every single senator in his caucus for a vote that would allow his historic health-care bill to move to the floor for debate? In the end, Reid won that victory, with caveats from a handful of reluctant senators. Hundreds of millions in Medicaid funds were handed to Sen. Mary Landrieu, D-La., for the very poorest of her state’s poor in exchange for her vote (a move Capitol Hill staffers dubbed the “Louisiana Purchase”).

The fate of national health-care reform rests on Reid’s ability to repeat his 60-vote feat in order to close debate and bring the bill to a final vote, and there’s no guarantee that he can. In fact, it’s looking a little dicey. But even among veteran Congress-watchers, there’s no consensus on whether or not Reid will succeed in the end. To do so, the majority leader will need to negotiate three points of contention. 

The Public Option

The suspense leading up to the vote ended when Sen. Blanche Lincoln, D-Ark., the lone Democratic hold-out, took to the Senate floor to announce that she would not join a Republican filibuster that would keep the bill from moving forward. But, Lincoln promised, she would not vote for a final bill that contains a public health-insurance plan. That may simply mean that she allows the bill to come to the floor but votes against it, knowing that Reid needs only 51 to win the bill after he clears the final procedural hurdle.

But Sen. Joe Lieberman, I-Conn., has promised to keep the bill from coming to the floor if it contains a public option of any kind, so that means Reid may have to find a way to lure Sen. Olympia Snow, the Republican from Maine, into keeping a filibuster away from his bill, and that would likely require a dramatic change to the public option as currently configured -- perhaps requiring states to “opt in” or setting some sort of trigger mechanism that would activate a public insurance plan only if insurance companies fail to meet benchmarks for cost containment. Sen. Ben Nelson, D-Neb., has made a similar threat.

Anti-abortion Language

Nelson of Nebraska has also threatened to filibuster any bill that does not include the unprecedented anti-abortion measures called for by the Stupak language attached to the bill passed by the House a week ago. Nelson is associated with the right-wing religious group known as The Family, to which Rep. Bart Stupak, D-Mich., the congressman who sponsored the anti-abortion amendment to the House bill, also belongs.

Stupak spent the last week setting himself up to be some sort of a broker of an abortion-language deal, appearing on both Fox News, where he promised to take a hard line during any future negotiations between members of the House and Senate in a conference committee, and on MSNBC's Hardball, where he seemed to be playing good cop. (The Stupak language goes far beyond current law, which simply forbids the use of federal dollars for abortion procedures -- a measure known as the Hyde amendment. Stupak's amendment essentially bars insurance companies from offering abortion coverage in polices offered to women receiving a subsidy for the purchase of insurance through a federally administered health-care exchange, even if the purchaser is buying that part of the coverage with her own dollars.) Stupak told Hardball host Chris Matthews that he might accept a compromise that would forbid private insurers who currently include abortion coverage in their policies from dropping such coverage.

Pro-choice House members have also laid down a marker, with as many as 40 saying that if the bill produced by a conference committee -- the last step in the legislative process before a final bill, where House and Senate bills will be combined -- contains the Stupak language, they won't vote for it. Rep. Diana DeGette, D-Colo., who co-chairs the House Pro-Choice Caucus with Rep. Louis Slaughter, D-N.Y., told AlterNet that she was engaged in discussions with pro-choice Senators Barbara Boxer, D-Calif., and Barbara Mikulski, D-Md., and was hopeful that the Senate would avoid the fate of the House bill with regard to abortion coverage.