Health bill reaches moment of truth

The House healthcare bill has taken more twists and turns and has zig-zagged its way through more Democratic districts than the Mississippi River.

And after a month’s worth of legislative wrangling and deal-making, the bill is approaching its final destination: a vote on final passage, expected sometime before the sun rises on Sunday. Pressing toward dawn on Saturday, the Rules committee passed a rule after nearly 12 hours that would set up a vote on the healthcare bill at 6 p.m.

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No Congress has ever come this close to the goal – first proposed by President Theodore Roosevelt – of providing universal health insurance.

But the healthcare waters are as perilous as they’ve ever been for the current group of Democratic leaders. Even on the day that many Democrats have been waiting decades for, and that some have based their entire careers around, a majority of votes for legislation to extend health insurance coverage to 36 million uncovered Americans remained elusive.

Democratic leaders, led by House Speaker Nancy Pelosi (D-Calif.), have given away as many concessions as they could spare in an effort to get to 218 "yes" votes.

And they continued to try to do so even late into the day Friday, as a pocket of pro-life Democrats needed further tweaking of language designed to guarantee that federal funds won’t find their way to insurance plans offering abortion coverage. Into the wee hours of Saturday morning, the Rules committee approved an up-or-down vote on an amendment blocking any money in its healthcare overhaul from funding abortions, risking the votes of members who support abortion rights. 

Anti-abortion Rep. Bart Stupak (D-Mich.) had told a bleary-eyed panel that a deal struck earlier in the day to move forward on the issue was off, before the rule was approved 6-4.

Energy and Commerce Chairman Henry Waxman (D-Calif.), who had been trying to broker a deal between as many as 40 pro-life Democrats and a number of abortion-rights Democrats, warned Friday evening that if one side needs to win, the entire bill would likely fail.

“I would like the [U.S. Conference of Catholic] Bishops, who as I understand it want a bill, to help us work out a plan where we don't have winners and losers,” Waxman said. “Because the losers will make us lose the bill and the winners won't have won anything.”

Abortion is just another in a long line of problems that Pelosi has had to steer around.

But between the concerns of anti-abortion Democrats, and additional unresolved concerns about the bill's cost, impact on the deficit and ability to control federal health spending from Blue Dog Democrats, and the possible revolt from a few liberal members who believe that the bill veered too far to the right during its infancy, Pelosi’s vote count appeared to still be short – perhaps by a considerable amount – heading into Saturday.

In fact, throughout the day Friday, Pelosi appeared to be losing more votes than she was locking down either through concessions or arm-twisting.

By 6 p.m. Friday, Democratic freshmen Reps. Frank Kratovil (Md.), Bobby Bright (Ala.), Walt Minnick (Idaho), Suzanne Kosmas (Fla.), Harry Teague (N.M.) and Mike McMahon (N.Y.) all announced their opposition to the bill after months on the fence.

A handful of vulnerable freshman from conservative districts – including Bright and Minnick – have been reliable “no” votes on just about everything Pelosi has shepherded through the House this year.

But Kratovil, Kosmas, Teague and McMahon all voted for the Speaker’s climate-change bill – votes that were critical to ensuring its passage when 44 Democrats joined all but eight Republicans in voting “no.” The bill passed by one vote.

The climate-change legislation – itself subject to considerable feuds within the Democratic Caucus – was pushed over the goal line in large part though considerable, last-minute lobbying from White House officials and President Barack Obama.

Obama on Friday was calling on-the-fence Democrats and stressing the importance of “moving the process forward,” according to one lawmaker who received a call. But the president’s impact was difficult to gauge.

Rep. Jason Altmire (D-Penn.), a member of the fiscally conservative Blue Dog Coalition, said calls from Obama and a host of administration officials still hadn’t gotten him to “yes.”

“The worst thing we can do is make the existing system worse,” Altmire said. “The second worst thing we can do is to do nothing."

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After canceling a trip to the Capitol on Friday, Obama was scheduled to meet with the House Democratic Caucus before noon Saturday at the Cannon House Office Building.

But even as late as 6 p.m. Friday, the scheduling staff of Democratic Caucus Chairman John Larson (D-Conn.) said they had no knowledge of when any meeting was taking place.

On Friday morning, House Majority Leader Steny Hoyer (D-Md.) warned that a planned Saturday night vote could be delayed until Sunday or next week if “delaying tactics” were employed. As of early Saturday morning, there were no signs that Republicans were planning such tactics during the debate, though GOP members hoped to stir some of Thursday's protest fervor against the bill with a second "House call" rally outside the Capitol at 1 p.m.

At the same time, Hoyer acknowledged that they were short votes, and speculation quickly spread through the caucus that Democrats might not be able to get there at all by Saturday night.

Altmire, who is leaning “no,” said he won't announce his vote before he casts it.

“It doesn't appear they have the votes,” Altmire said Friday afternoon. “They appear to be a fairly decent amount short.”

All 177 House Republicans have long been expected to vote against the bill, meaning that Democrats can lose no more than 40 of their 258 members and still pass their highest legislative priority.