Dem split on the public option casts doubt on reform of healthcare

Democratic aides and lawmakers are questioning how their party can pass a health reform bill next month with centrists and liberals at odds over a core aspect of the legislation.

Speaker Nancy Pelosi's (D-Calif.) has pledged to include a government-run insurance option in the House bill that will be voted on next month. This reassures liberals but will make it difficult or impossible to get the votes needed to pass it if the public option is included.

Bruised by a tough vote on climate change legislation in June, burned by fiery town hall meetings in August, and worried about the midterm elections to be held in November 2010, Democratic centrists and vulnerable lawmakers in the party are signaling that they are not happy with Pelosi's plan.

"I don't see how we get to 218," said a senior Democratic aide. "The Blue Dogs are ‘Hell nos.’ The people who voted yes [on energy] want to vote 'no' twice."

Still, even skeptics note that Pelosi has almost never lost a vote in the House since becoming speaker. They figure she will try to tough it out vote by vote until she gets the 218-vote majority she needs, much as she did on the climate change vote.

One Blue Dog said Pelosi's pledge to include a public option favors her liberal base in the Democratic Caucus.

"They're playing to people who can't get beat by Republicans," said the lawmaker, who plans to vote against the bill if it remains in its current form.

He suggests Democratic leaders dramatically scale back their ambitions and work with Republicans to pass a bill. The House could easily pass legislation if the bill contained costs and forced insurance companies not to deny coverage to people based on their pre-existing health conditions.

"There's not a critical mass of public support around here for a major overhaul," he said. "We ought to do incremental reforms and make Republicans vote for it."

Other Blue Dogs say overhaul legislation can be done if it is brought back to the center of the political spectrum.

"I think it's pretty clear this bill needs more work," said another Blue Dog. "If it's not done right it will be something the American people won't accept. That is a message the leadership needs to heed. We're not going to be jammed."

The centrists’ concerns were reflected earlier this month when House Majority Leader Steny Hoyer (D-Md.), leadership's liaison to the Blue Dogs, suggested a public option might need to be dropped to pass a bill.

"I'm for a public option, but I'm also for passing a bill," Hoyer said.

This comment contradicted Pelosi's statement a day earlier that she could not get a bill through the House without a public option.

Her defenders note, however, that she successfully steered it through three committees. They say pessimism is premature, if not misguided.

"It's a favorite Washington game to announce the score before the game is finished," said a senior aide close to negotiations on the bill. "There is no appetite in this Congress for failing to pass health insurance reform."

The public option is just one sticking point for Democratic members. Many, especially freshmen from conservative districts, do not like the income surtax on high earners that Pelosi wants to impose in order to pay for the bill. Centrists think the bill is too burdensome to small business, and that its $1 trillion price tag is too high.

"I think we should squeeze the savings out of the current system … without...a surtax – I think that's a misguided policy," said Rep. Jason Altmire (D-Pa.), a Blue Dog who voted against the bill in committee.

Others worry that Pelosi is trying to force centrists to vote for provisions that are unpopular in their districts and may never become law. They want to see a bill from the Senate Finance Committee, which is unlikely to include a public option, before they vote.

The House bill is still being modified. The three committees that approve versions of the bill are melding their drafts, and the bill could change substantially. The final version for the floor vote will be in the hands of the Rules Committee, and ultimately of Pelosi.

There is strong support among House Democrats for a government-run health insurance plan that would compete with private insurers. House leaders have also distributed polling data to the Caucus showing strong voter support for it.

But with Republican opposition expected to be nearly universal, Pelosi will need centrists if she is to win a simple majority.

If Republicans all vote against the bill, the Speaker can afford only 38 defections. There is no clear count, but there are signs of trouble.

There are 52 Blue Dogs, more than enough to block a bill. Some of the most conservative, including Reps. John Tanner (D-Tenn.), Charlie Melancon (D-La.), John Barrow (D-Ga.) and Jim Matheson (D-Utah), voted against the bill in committee.

Reps. Dan Boren (D-Okla.) and Parker Griffith (D-Ala.), among others, have told town hall audiences that they will oppose a public option. Griffith even said he wouldn't vote for Pelosi again as speaker.

But Blue Dogs aren't unanimous. At the less conservative end, Reps. Mike Thompson (D-Calif.) and Jane Harman (D-Calif.) have voiced their support. Several others like Rep. Joe Baca (D-Calif.) and Rep. Loretta Sanchez (D-Calif.) have signed statements that they support a public option.

In the middle, Blue Dog Reps. John Salazar (D-Colo.) and Michael Arcuri (D-N.Y.) have told hometown media outlets that they support a public option.

But dissatisfaction extends beyond Blue Dogs. Rep. Rick Boucher (Va.), a conservative Democrat but not a Blue Dog, says he doesn't like the public option. Rep. John Adler (D-N.J.) told an audience, "The bill that's coming through the House, with or without the public option, isn't good for America."

The Democrats' most vulnerable new members from conservative districts are also concerned. Rep. Betsy Markey (D-Colo.), elected in 2008 in a heavily Republican district, supports a public option. But she told voters during recess that she opposes the bill "in its current form" because of the surtax and overall cost.

That leaves Pelosi caught in an increasingly bitter feud between her liberal and centrist factions. On the liberal side, 60 members of the Congressional Progressive Caucus signed a letter saying they would oppose a Blue Dog deal that they believe would weaken the public option. When the administration indicated this month that the public option was not essential to health reform, Rep. Anthony Wiener (D-N.Y.) said dropping it could cost the bill 100 votes.

Even with the public option, there are "no" votes on the left. Rep. Eric Massa (D-N.Y.), who supports a single-payer system, has told voters he opposes it because the public option is too weak, it will increase the budget deficit, and it "shifts too much power to the pharmaceutical industry," according to a spokesman.

Liberal frustration with Blue Dogs is growing. In a conference call Thursday, liberal Rep. Pete Stark (D-Calif.) said Blue Dogs are "brain dead," and "just looking to raise money from insurance companies."

Rep. Lynn Woolsey (D-Calif.) co-chairwoman of the Progressive Caucus, said liberals face political consequences, too.

"Most of my constituents want single-payer," Woolsey said. "If we can't even pass a public option, they could vote me out of office. We'd have primaries. What do they think happens to progressives?"