Does Obama Have the Votes for Health Care Reform?

Last Thursday, Barack Obama tried to convince the members of the IOC that Chicago deserved the 2016 Olympics. He failed miserably, as Chicago was eliminated on the first ballot, a humiliating defeat for Obama personally and the United States. So much for the new love of America overseas.

Now the president is back to home turf, where the numbers in the Senate and the House continue to favor passage of the president’s key domestic priority this year: a health care reform bill. The key numbers are these: the Democrats have a near 80-vote margin in the House and a 60-40 hold on the Senate, including the two independents who tend to vote with the Democrats. The attainment of the filibuster-proof majority in the Senate owes to the circus act just performed in Massachusetts, where the legislature and the governor  agreed to change the law for the second time in five years on how to fill a Senate vacancy.

Paul Kirk, the new senator for four months, provides the 6oth Democratic vote during the period when a health care form bill is expected to be considered in the Senate. At this point the Democrats do not need a single Republican in either body of Congress to pass the health care reform bill. So what could go wrong for the administration?

My own assessment of how the bill progresses through Congress goes like this:

In the House, three committees have already approved a bill that includes a public insurance option, which would create a new federal program that would compete with private insurers for the business of individuals and small businesses. Each bill is priced at more than $1 trillion over 10 years and relies on higher taxes on the wealthy to finance a substantial part of the price tag.

The bill that will come out of the House will look just like the bills from the three committees and is troubling for the 52 Blue Dogs and other Democrats in vulnerable seats (84 members hold seats in districts won by either Bush or McCain in 2004 and 2008). Much as with the House cap-and-trade bill, when over 40 Democrats voted no, my guess is that close to 40 Democrats will vote no on the House bill, enabling them to say to constituents that they opposed the public option and higher taxes. But the bill will pass the House narrowly.

The Senate will consider a different bill -- one that can pass in Max Baucus’ Senate Finance Committee. It will not have a public option, will not be as generous on subsidies for purchasers of the new policies, will have a somewhat lower price tag, will have some tax on high-priced policies (to be borne by insurers and then passed on), and will have a few throwaways to try to lure a Republican vote or two (e.g., allowing cross-state selling by insurers). This bill will not get 60 Democratic votes on the floor, but will likely get the 60 votes required for cloture, and a floor vote. It is, I think, highly unlikely that Democratic senators who are unenthusiastic about the bill, such as Nebraska’s Ben Nelson, will vote with the GOP to sustain a filibuster.  It would take 11 Democrats to then break away to defeat the bill on the Senate floor -- and it is hard to see who those 11 might be. I see the bill passing the Senate with 50-55 votes in favor.

The two different bills will then go to a conference committee to wrangle out the differences. Most likely, what will emerge will be a bill without a public option but with a trigger, and perhaps a state opt-in for a public option as well as other features that more resemble the Senate bill than the House bill. This will anger the progressives in the House, but they will settle for the half or ¾ loaf. Both the progressives and moderates will crow about what they achieved in Conference.

When the revised bill comes back to each body of Congress, it will pass with a slightly bigger margin in the House (a more palatable bill for the Blue Dogs) and with about the same margin in the Senate.

So what can derail this scenario? Two things could gum up the path I have outlined. If the GOP wins both the Virginia and New Jersey governors’ races, that will make Blue Dogs and other endangered Democrats think twice about putting themselves on record with a bill that is not popular with the public. The Republican candidate, Bob McDonnell, looks to be in very good shape in Virginia despite a smear campaign against him orchestrated by the Washington Post. Republican  candidate Chris Christie is narrowly ahead in New Jersey.

The second factor that could damage the bill’s prospects is weak public support for comprehensive reform. Many surveys are showing declining support for any significant health care reform bill. A recent Rasmussen survey showed 41% support, 56% opposition to the current bills in Congress and a new Fox/Opinion Dynamics poll shows a 20-point negative margin. A majority of voters think reform is necessary, so obviously it is this particular proposed reform that is less popular. If these numbers stick, or further deteriorate, it will become much harder to push through a comprehensive bill.

There has never been a major piece of legislation that impacts the nation in such a large way that has  passed with no support from the minority party and with a majority of Americans opposed to it.

Politicians care most about one thing: preserving their jobs. If supporting health care reform gets too risky, the bill might not pass. It is not hard to figure out why the airwaves are full of pitches for both sides of the health care reform debate, and why there is so much attention focused on New Jersey and Virginia.