Roving thoughts and provocations

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Why Health Care Reform is Going to the Dogs

Canine checkup (independent.com)

So what did the House Blue Dogs do on the health care vote last Saturday? They were more supportive than one might think: Of the fifty-two-member coalition, twenty-eight voted yea and twenty-four nay. Jim Cooper of Tennessee, the Blue Dog whom I identified in my piece in The New York Review as being among the most knowledgeable legislators in the House on the issue, told The Washington Post’s Ezra Klein: “This was one of the best votes I ever cast.”

That majority-level of support from these moderates came, however, with an asterisk. It seems fair to say that many of them were made more comfortable with the overall bill because of the stringent anti-abortion amendment approved earlier Saturday evening and sponsored by Blue Dog Democrat Bart Stupak of Michigan. That amendment would bar women from receiving coverage for abortion services even if they have private insurance, if that insurance has been obtained with the help of federal subsidies. Under both House and Senate bills, people are required to buy insurance, and the government would subsidize those with incomes up to four times the federal poverty level to help them make the purchase. These women—with household incomes up to $88,000 for a family of four—would be affected.

Concerns about the implications of health care reform on federal abortion funding have simmered (and sometimes boiled) for months. As I wrote in the piece, an amendment by Lois Capps of California seemed at one point to satisfy most Democrats. But Stupak wasn’t among them. The Capps amendment was, to my eye (conservatives disputed this), in line with existing federal law: The Hyde amendment, which bars direct federal funding of abortion services. But Stupak, working with the US Conference of Catholic Bishops, whose members seemed to be deeply involved in negotiating eleventh-hour details, according to Politico, pushed for language that goes beyond Hyde and prohibits even indirect federal funding of abortion. It passed 240-194.

Fifteen of the twenty-eight Blue Dogs who backed the House bill also voted for the Stupak amendment. We don’t know how many would have voted for final passage without Stupak, so we’re a bit in the realm of speculation here. But we do know that the bill barely passed, by 220-215. And Cooper told Ezra Klein that Nancy Pelosi and the House leadership were sweating the margin virtually until the last minute: “I think the actual number [of solid yea votes] was closer to 210. The leadership had to move heaven and earth to get to 220. The achievement of the leadership was to corral the votes at the last minute, and that is a great achievement that should not be diminished, and they did that by making major concessions they didn’t want to make.” In other words, it seems reasonable to say that without Stupak, moderate Democrats would have denied the bill enough votes for passage.

So, in essence, the Blue Dogs won another round. They’d already won on the public option, which was weakened in the final House bill to a point Pelosi had spent months saying she would not permit: She wanted a public option with reimbursement rates pegged to current Medicare rates plus 5 percent, which would likely have enabled the new federal insurer to offer prospective customers better coverage plans, but she got one in which rates have to be negotiated with insurers. And now, most Blue Dogs (thirty-six of them voted for Stupak) and a coalition of other members who are mostly liberal but moderate on abortion for religious or constituent-based reasons, have made the bill more conservative still. Liberal pro-choice Democrats in the House and Senate such as California Senator Barbara Boxer and Florida Representative Debbie Wasserman Schultz vow to remove the Stupak language as the bill proceeds along, and President Obama said he hoped the language could be re-jiggered.

The bottom line, though, is this: Liberals threaten to drop their support for the bill if the Stupak language is included, while moderates threaten to drop their support if the language is excluded. Which side’s threats are Democratic leaders likely to take more seriously? The dogs. As long as that is the case, they will retain more leverage over the final product.

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