Pelosi kept public plan in the frame

When her fellow Democrats in the Senate were calling a public plan dead on arrival, she made it clear that House Democrats were talking about what kind of public option they would pass — not whether they would pass it. She stood strong when they suggested nonprofit “co-ops” were a better way to go.

And when a bitter feud between Democratic factions over the public option threatened to sink the bill, she patiently walked them back from the brink.

On Saturday night, defying the critics and the many pundits on the cable shows, Pelosi passed a bill that includes a public option.

Across the Capitol, Senate Majority Leader Harry ReidHarry Mason ReidMcConnell not yet ready to change rules for Trump nominees The Hill's Morning Report — Sponsored by CVS Health — Trump’s love-hate relationship with the Senate Trump to press GOP on changing Senate rules MORE (D-Nev.), who had earlier embraced the co-op idea, is also pursuing a public option, albeit a different one from Pelosi’s. Two months ago, conventional wisdom had buried the public option. But Pelosi refused to let it die.

The House’s passage of the government-run plan is a testament to Pelosi’s perseverance, tactics and vote-counting abilities. It’s also a demonstration of how she manages the different factions of her caucus.

“There was no question in her mind that the bill would include a public option,” said Pelosi spokesman Nadeam Elshami. “She was talking about that in July. She was talking about that in August during the town halls.”

Pelosi’s bumpy journey to pass healthcare reform including turns to both the left and right as she sought to thread the needle to 218 votes needed for passage. It required a lot of patience and  arm-twisting, along with a few side deals.

After the rare weekend vote, fellow California Democratic Reps. Jim Costa and Dennis Cardoza touted new funding for projects and facilities in their districts coming as a result of the House’s health legislation.  Both of the lawmakers, who hadn’t pledged their support for the bill until shortly before the vote, released statements promoting what they had secured for their constituents.

In his release, Costa, who opposed the House climate change bill, said, “During my negotiations to help improve the bill for our valley, I was able to achieve funding for a medical school in the valley, with studies at UC Merced and residency in Fresno, as well as additional incentives to bring health professionals to our valley.”

The public option, as passed in the House bill, is a government-run health insurance plan that would compete with private insurers to guarantee coverage to the people the bill requires to obtain insurance. Since many regions now have little competition, it is expected by congressional scorekeepers to drive down costs.

The idea of the federal government getting into the health insurance business proved to be one of the most difficult concepts in an overhaul that includes myriad changes in the way Americans pay for their healthcare.

Before town hall protesters in August deemed it a “government takeover,” centrist Blue Dog Democrats demanded changes. Pelosi and her colleagues in the liberal wing of the party wanted a plan with reimbursement tied to Medicare rates, plus 5 percent.

Seven Blue Dogs on the Energy and Commerce Committee threatened to block the bill until Pelosi and committee Chairman Henry Waxman (D-Calif.) rewrote the plan to divorce it from Medicare and instead allow hospitals and physicians to negotiate their pay rates with the government.

But that provoked a furious response from liberals. The Congressional Progressive Caucus gathered the signatures of 60 lawmakers who vowed to vote against the bill if it included the Blue Dog compromise. Pelosi quickly said she didn’t feel bound by the compromise.

The impasse carried into the August town halls, where conservative activists attacked every aspect of the bill, and a few that weren’t there. But the intra-party bitterness continued, too. Rep. Pete Stark (D-Calif.) said publicly what many of his fellow liberals were saying privately, that the Blue Dogs were “brain-dead” and just wanted “to raise money from the insurance companies.”

Pelosi supported the Medicare-based public option, which supporters dubbed “robust.” She stressed that the Congressional Budget Office concluded it saved $85 billion more in costs than the centrist “negotiated rates” compromise.

And the polls were holding steady in support for the public option even as support for the overall plan and Obama sank.

To get the public option in the bill and pass it, she had to give in and go with negotiated rates. And she had to do that without losing so many liberal votes that the bill would fail.

She found a strategy that would work when she offered the liberals what they wanted if they could make it work. She told the Progressive Caucus members to see if they could find the votes they needed to pass it. Republicans had made it clear they would unite against it, so Democrats believed all 218 votes needed to come from their caucus.

The liberal option enjoyed overwhelming support among House members, but support topped out around 200 votes. That provoked angry confrontations between Progressive Caucus leaders and House Majority Whip James Clyburn (D-S.C.).

Blue Dogs were also increasingly angry that Pelosi was backing out of the Energy and Commerce compromise and seeming to push the liberal version of the public option.

She told them she needed the strongest possible public option, because it would get watered down on the Senate side.

“The bill hasn’t gotten any better since July,” one Blue Dog said at the time.

Progressive Caucus Co-Chairman Raúl Grijalva (D-Ariz.) and others pressed Pelosi to keep the liberal version alive. He said Pelosi and the other leaders could have leaned on enough members to put them over the top.

But she declined. And when they finally voted Saturday night, only two of the 60 Democratic members who signed the letter opposing the centrist compromise voted against it: Reps. Dennis Kucinich (Ohio) and Eric Massa (N.Y.).

“We got the best possible bill we can pass,” said Rep. James McGovern (D-Mass.), who signed the letter but voted for the bill. “Getting the best possible bill you can’t pass isn’t legislating, it’s therapy.”