Public option to abortion: Key moments in Obama’s struggle to pass health bill

The difference between the passage and failure of health reform arguably came down to the Democrats’ ability to take a punch, a 7-hour White House summit and 312 votes in a Minnesota Senate race.

President Barack Obama and his allies on Capitol Hill overcame seemingly insurmountable obstacles and achieved a goal that eluded leaders for nearly a century when they put into law national healthcare reform.

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The eventful year-plus odyssey featured soaring highs like Obama’s signing ceremony on Tuesday and calamitous lows, most notably losing Sen. Edward Kennedy’s (D-Mass.) old seat.

But in the end, Obama, House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) maneuvered their way to success.

Here’s a look back at some of the key breaking points in the battle for healthcare reform.

Democrats took a massive punch and kept swinging. After failing to meet Obama’s deadline for the House and Senate to pass bills by Aug. 1, 2009, Democratic lawmakers went home only to be greeted by boisterous crowds at town hall meetings that seized the media spotlight and cemented the narrative that voters were not on board with healthcare reform.

Rather than shrinking away from the pressure, as Democrats did when President Bill Clinton’s healthcare platform ran into trouble, Pelosi and her lieutenants redoubled their efforts when September came, striking compromises between the liberal and centrist wings of her caucus to get the bill through committee and prepare it for a razor-thin vote in November.

Obama chipped in, too, by paying a visit to the Capitol for a prime-time televised address to a joint session of Congress.

However, his speech wasn’t a game-changer and it is best remembered as the night Rep. Joe Wilson (R-S.C.) shouted “You lie!” at the commander-in-chief.

In the Senate, Finance Committee Chairman Max Baucus (D-Mont.) finally gave up on his dream of crafting a grand bipartisan deal with members of his “Gang of Six” senators and moved his bill through a grueling, prolonged committee markup that enabled Reid to propel forward with the stalled effort.

The president’s plan. Democrats on both ends of Pennsylvania Avenue reeled after Sen. Scott Brown (R-Mass.) won Kennedy’s seat in a special election. Panicked rank-and-file Democrats were openly calling healthcare reform dead and urging their leaders to abandon the effort and scale back their ambitions. Seemingly feeling the after effects of the Brown triumph, Obama himself seemed to encourage this idea in the days after the special election.

Soon thereafter, Obama went on the offensive. The president took the compromises forged between him, Pelosi and Reid in the days before Brown’s victory and presented them to America as his plan, not something hatched up in the sausage factory on Capitol Hill.

He also announced on Super Bowl Sunday that he would host a televised, daylong bipartisan summit meeting. This came after he gained momentum by winning a public debate with House Republicans at their retreat in Baltimore.

Most importantly, the two public forums showed that Obama had learned from a big mistake that almost cost him his No. 1 domestic agenda priority. By shifting gears from working behind the scenes to taking on his critics while the cameras rolled made up for the president’s broken promise that healthcare negotiations would be broadcast on C-SPAN.

The seven-hour summit stiffened the backs of congressional Democrats but Obama didn’t let up. Obama’s personal lobbying won over at least a few votes, not least of which was Rep. Dennis Kucinich (D-Ohio), whose hard-won support put a liberal imprimatur on the legislation.

And Franken makes 60. After a recount and a lot of legal maneuvering, Al Franken (D-Minn.) was determined the winner over former Sen. Norm Coleman (R-Minn). Franken officially won by only 312 votes.

Franken gave Democrats their coveted supermajority in July of 2009. Had Coleman won, Democrats may not have been able to pass comprehensive health reform in the 111th Congress.

With Franken sworn in, and Sen. Arlen Specter (Pa.) newly ordained as a Democrat, Reid had power to block any Republican filibusters. Combined with a huge majority in the House and an ambitious president in the White House, Democratic congressional leaders were poised to do big things – if they could keep their fractious caucus united.

It wasn’t easy to get there – and some of the side deals struck along the way turned out to be politically toxic – but Reid managed the seemingly impossible and got all 60 Democrats to stand together on Christmas Eve and pass the healthcare reform bill that eventually became the foundation of the new law.

The death of the public option. There’s never a shortage of Democratic infighting but the one issue in healthcare reform that divided the party more than any other was the proposal to create a government-run public option insurance plan that would compete with private companies.

To liberals, it was the consolation prize for giving up the dream of erecting a federal single-payer healthcare system. To centrists -- especially those elected in conservative districts and states -- the public option was the Trojan horse for the government takeover of healthcare.

Liberals outnumber centrists in the House and the Senate but the centrist bloc commands enough votes to hold up legislation and they used that power to great effect in both chambers.


Blue Dog Democrats succeeded in watering down the House’s version of the public option though centrist Senate Democrats did them one better. Months of attempts to find the sweet spot – a public option that would please liberals but not alienate centrists – came to screeching halt because Sen. Joe Lieberman (I-Conn.), the onetime Democratic vice presidential nominee turned independent and supporter of Sen. John McCain’s (R-Ariz.) White House bid, refused to budge.

A group of 10 liberal and centrist senators, tasked by Reid to resolve their differences over the public option and other issues, arrived at a tentative agreement and the path forward began to seem cleared. The optimism didn’t last long, though, as Lieberman took to the airwaves to proclaim what he had privately told Reid: Any bill with any form of the public option would not get his vote.

With Lieberman on the side of the Republicans, Reid faced the prospects of a filibuster that would crush healthcare reform. So Reid turned to his mainly liberal caucus and presented them with choice: Swallow a defeat on the public option or accept failure on the entire project. The liberals chose the former.

Meanwhile, Pelosi – who had fought so hard to keep the public option alive in 2009 – was the one to bury it in early 2010, noting the votes were simply not there in the Senate.

Solving the abortion dilemma. Probably the most divisive issue in American politics, it was perhaps inevitable that the push for healthcare reform would spark a fight over abortion. That abortion would prove the toughest nut to crack and the last problem Pelosi had to solve, however, was less predictable.

Each time a healthcare reform bill came to the House floor – in November and again in March – Pelosi found herself just shy of the votes she needed.

The Speaker was forced to turn to anti-abortion-rights Rep. Bart Stupak (D-Mich.) and his band of allies who supported healthcare reform but firmly believed the legislation was written in a way that would upend the longstanding prohibition against taxpayer funding of abortion services.

The “Stupak dozen,” as they came to be called the second time around, had the support of Catholic bishops and other influential abortion-rights opponents. Abortion-rights supporters were angry that Pelosi, the first female Speaker of the House and a leader in their movement, would entertain scaling back access to abortions and threatened to defect.

When the House passed the bill in November, it happened only because Pelosi put Stupak’s abortion language up for a vote, and it passed easily. Pelosi promised abortion-rights lawmakers that the Senate would fix their problem and she turned out to be half right.

Sen. Ben Nelson (D-Neb.) wanted to add the Stupak language to the Senate bill but failed to gather the support he needed. Instead, he devised alternative language that both camps begrudgingly accepted.

But Stupak and his allies on and off Capitol Hill rejected the Nelson language, setting up another showdown. As she did in November, Pelosi realized she needed Stupak’s votes to pass her bill but pro-abortion-rights Democrats weren’t willing to play ball this time. Instead, it was Obama who came to the rescue by promising Stupak he would sign an executive order affirming that no federal funds would go to abortions. That didn’t satisfy anti-abortion rights activists but it was good enough for Stupak and other like-minded Democrats.

The bill passed by a few votes and was signed into law a couple days later.