The parallels to 1994 — the last time health reform died — are unmistakable.
Democratic senators huddled for weeks in backroom meetings, groping for a workable alternative. Some of the attempts at reviving it were genuine, while others were only designed to suggest forward progress, observers recall. After four or five weeks, the effort was abandoned as Democrats geared up for the midterm elections.
The same signs are all there for health care, circa 2010. No one in Congress will say it’s dead, but smart people can’t figure out how it stays alive.
Look at the signs: White House chief of staff Rahm Emanuel last week said health reform had to wait its turn in line, right after jobs and regulatory reform — a process that would put it months down the road. Senate Majority Leader Harry Reid (D-Nev.) seemed in slow-walk mode, only promising movement “this year.” These are the same people who spent months arguing that reform had to be jammed through quickly, or it would fail.
“They were right the first time,” said Lawrence O’Donnell, the Democratic staff director for the Senate Finance Committee during the 1993-94 Clinton health care debate. “There’s no such thing as ‘Let’s take a pause in legislating so that we can gain momentum on it.’ It’s insulting.”
Since the Massachusetts election, O’Donnell said, Democrats have moved into “full bluff mode.”
The pathways to save it are impossibly narrow, each loaded with problems.
And Democratic leaders, while voicing support to proceed, have yet to make up their minds about which one to choose.
— Option 1: Reid and House Speaker Nancy Pelosi are trying the 51-vote reconciliation route. The idea would be a pass a bill to “clean up” the Senate bill. Reid can afford to lose nine senators — and at least eight senators are on record saying they oppose reconciliation or have strong reservations about using it. At least two more — Sen. Robert Byrd (D-W.Va.) and Sen. Russ Feingold (D-Wis.) — have been historical opponents of reconciliation.
— Option 2: President Barack Obama keeps floating a break-up-the-bill approach.
Carving the bill into bite-sized chunks has a surface appeal to Democrats — not least of which is putting Republicans on the spot to oppose popular reforms — but which chunks? Who picks the winners and losers? Democrats couldn’t satisfy everyone in their caucuses when they had 2,000 pages of legislation and nearly $1 trillion to work with, so it’s harder than it looks.
— Option 3: Obama’s press secretary, Robert Gibbs, on Sunday was still talking up the pathway where the House just passes the Senate bill and sends it to Obama’s desk. It’s true — the House could vote any time to do that, and the nation would have health reform. But Pelosi’s already said the House won’t do it.
The California Democrat has a larger problem, going back to Option 1. It’s not at all clear she still has 218 votes to pass a sweeping health reform plan anyway. She only got 220 votes the last time, Rep. Anh “Joseph” Cao (R-La.) says he’s a “no” vote now and one of her “yes” votes retired.
And it’s not like any of these paths are quick and easy.
Pursuing a scaled-backed bill or a series of incremental reforms would still take weeks, if not months, and the end result would fall well short of the Democratic vision of a comprehensive overhaul.
Reopening negotiations with Republicans could set back passage for months or longer, with no guarantee that it would even happen.
And reconciliation, which would allow Democrats to circumvent the Senate’s 60-vote threshold for passage, has two problems. One, it’s hard to know which parts of reform the all-powerful parliamentarian would rule germane under the complex rules for reconciliation.
And two, and worse for Democrats, Republicans would have a field day blasting it as yet another shortcut, yet another example of the deal making needed to get the bill across the finish line — a kind of “Cornhusker Kickback” for the whole bill.
Here’s the scariest part for Democrats: Despite all that, reconciliation is still the best chance of getting anything approaching Obama’s original vision of reform.
“You get one more shot at this without any margin of error,” said a senior Senate Democratic aide.
Democrats may well decide the risk is worth it. Congressional leaders and their staff have been researching the procedure, weighing the pros and cons behind closed doors and making all the right commitments in public to keep the process moving.
There is a still sizable contingent of Democrats who continue to believe failure is not an option, even though their voices have been softer since the Senate loss in Massachusetts. Obama, Pelosi and Reid, by all accounts, still agree with this thinking and remain sincerely committed to pushing ahead. Most Democrats have already voted for the bill, making them more invested in finishing the job than their counterparts were in 1994.
A Senate leadership aide said senators were aiming to make a decision by the end of this week.
But the top Democrats have been left to make the decision on their own, without any public direction from the president — a move that doesn’t inspire confidence that a quick solution is forthcoming.
“It’s been two weeks since the massacre in Massachusetts. What are we doing?” a second Senate Democratic aide said. “The president has to step up to the plate and tell us what he wants to do and lead the effort.”
A White House official has said the president is in “close consultation” with leadership, and they know where he wants the process to go.
The hesitation of Democrats to use reconciliation is galling to Ron Pollack, the executive director of Families USA and a longtime advocate of health reform.
Congress has used reconciliation to pass 19 laws since 1980, including the 1996 welfare reform bill and the 1997 children’s health insurance program. Former President George W. Bush caused controversy by employing the fast-track rules to approve two rounds of tax cuts that were paid for through the budget surplus.
To Pollack, the choice is clear. Reconciliation has been used for health care measures in the past, the current health care bill would reduce the deficit and the procedure allows the majority to exercise its will, he said.
“I don’t understand what the risk is if it has been used a number of times,” Pollack said. “What is the problem?”
One problem is that Republicans also can offer an unlimited number of amendments that receive votes after the 20 hours of debate ends. This means senators could be forced to cast dozens of votes that could go on for days.
And that is another way that history could repeat itself — because in 1994, health reform died of a thousand cuts.
After struggling for most of that year, Senate Democrats brought a health reform bill to the floor in August. Republicans successfully picked it apart with targeted amendments that were politically impossible for Democrats to oppose.
After about a week, then-Senate Majority Leader George Mitchell (D-Maine) pulled the bill from the floor saying they would tackle it again after recess, O’Donnell said.
Within a month, health reform was dead.