Democrats’ threats to hold healthcare reform hostage dominate the debate

The myriad of threats has been a headache for senior White House officials and congressional leaders who have to determine the difference between what lawmakers want and what they absolutely need in order to get them to “yes.”

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The requested ransom has varied, ranging from language on a public option, abortion, Medicare payment rates and immigration. At times, different groups of Democrats have demanded opposing language on these and other issues.

That is why the House effort to pass healthcare reform stalled for months, and why Senate Democratic leaders are struggling to find a bill, any bill, that will get 60 votes.

While liberal senators such as Sherrod Brown (D) of Ohio, Roland Burris (D) of Illinois and Bernie Sanders (I) of Vermont have threatened to oppose any final reform bill without a “strong” public option component, conservatives like Ben Nelson (D) of Nebraska and Joe Lieberman (I) of Connecticut have vowed just the opposite: to block any bill that contains such a component.

Meanwhile, a Medicare buy-in provision for Americans between 55 and 64, drafted recently by Democrats like Mary Landrieu of Louisiana — also a public-option opponent — wasn’t good enough to satisfy Nelson or Lieberman. Both vowed on Sunday to oppose it, and the combined threats have led Democrats to the verge of scuttling both the public option and buy-in ideas. That may win the support of Nelson and Lieberman but imperil the votes of liberal members.

Sen. Claire McCaskill (D-Mo.) on Sunday issued a new threat of her own, vowing to oppose any bill that swells the deficit and increases healthcare costs. Otherwise, she said, Democrats should go back to the drawing board.

 With few, if any, Republicans expected to support health reform, leaders have been forced to scramble to satisfy every member of the Democratic Conference in the Senate. It hasn’t been easy.

 “Everyone feels they are the 60th vote, and they’re exercising that power,” said one senior Democratic aide. “It’s not about the subject of healthcare, it’s about the numbers. If we had 63 or 64 votes, you wouldn’t see this. But because they feel empowered, the only thing to do is to take them all seriously.”

 That task has fallen mainly to Majority Leader Harry Reid (D-Nev.) and Majority Whip Dick Durbin (D-Ill.). The duo have divided up the list of senators with demands, with each handling his tasks in different ways. Reid prefers face-to-face meetings in his office, for example, while Durbin opts for phone conversations.

 Liberals like Sen. Jay Rockefeller (D-W.Va.) say they are frustrated with the trend because it can thwart needed legislation. During the Finance Committee debate on healthcare this fall, Rockefeller emerged as a passionate voice for a public option plan. After he said he couldn’t vote for the Finance panel bill — which did not include a public option — President Barack Obama met with him at the White House. Rockefeller subsequently voted for the committee measure.

On Monday night, as Democrats entered a caucus room with the idea of a public option all but gone, Rockefeller said he was frustrated that a single senator could decide its fate.

 “But when you have no votes to spare, everybody can be that if they want to be,” he said.

 Centrist Democrats like Mark Pryor of Arkansas, who has not issued any public threats on his vote for the bill, said he would be surprised if any senator followed through and stood alone as the single vote to block healthcare reform.

 “That would be a very difficult position to be in,” he said. “It depends on your convictions and your state, but that would be a very difficult position to be in.”

 But other centrists, like Nelson, said they would find such a position comfortable because their threats reflect their state’s politics.

 “I would say it like this: How would I feel voting for something that I didn’t feel was good for the people of Nebraska?” he said. “I wouldn’t feel very good about that. Maybe it’s a Hobson’s choice, but sometimes we’re called on to make those, and this happens to be bigger than most of them.”

 Liberals like Sen. Ted Kaufman (D-Del.), who has worked in Congress for 36 years as a former chief of staff to former senator and current Vice President Joe Biden, said the atmosphere of threats is nothing new, but has increased in proportion to the historic nature of the healthcare vote.

 “It only happens when you’re on the cusp of 60 or the cusp of 50. It isn’t because they feel empowered. It’s because they are empowered,” Kaufman said. “Someone like me doesn’t have any credibility, because I think Congress on its worst day can’t come up with a bill that’s worse than the current system. So I don’t have any leverage to say, ‘I want this, this and this,’ because I think we need it so badly.”

 Jennifer Duffy, a senior editor and Senate analyst at The Cook Political Report, said it is difficult to tell which senator is most likely to follow through on his or her threat.

 “The most consistent is Lieberman,” Duffy said. “The liberals really haven’t been tested lately, because when they’ve made good on threats it was with a Republican president and Republican Senate. I suspect some are indeed serious.

“Here’s the real problem: If they honestly want 60 votes, they’ve got to play ball with everybody. That’s a bigger problem, when you have someone like Lieberman, whose interests are very different than the liberal bloc. It’s hard to tell how you give liberals what they want and get Lieberman’s vote.”

Like Kaufman, Duffy said the prominence of the coming healthcare vote is creating a lot of the voting threats, disagreeing with the premise that it is simply a matter of math.

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 “I don’t think there is any member up there that doesn’t appreciate this could be the most important vote of their career,” she said. “I think the numbers complicate the issue; the issue doesn’t complicate the numbers.”

In passing the House bill, Speaker Nancy Pelosi (D-Calif.) needed to assess whose threats were real.

Rep. Bart Stupak (D-Mich.) claimed he and about 39 other Democrats would vote no unless they got a vote on his anti-abortion rights amendment. Needing firm yes votes, Pelosi took Stupak’s threat seriously and agreed to allow a vote on the measure, which passed easily.

Earlier this year, 60 liberal-leaning Democrats suggested they would reject a House healthcare bill that did not have a “robust” public option that called for providers to be paid based on Medicare rates.

That version of the public option was discarded. It didn’t cost Pelosi even a handful of votes.

And after cutting a separate deal with centrists this summer, Pelosi scoffed at the notion that liberals would reject the House bill, saying, “Are you asking me, ‘Are progressives going to vote against universal, quality, affordable healthcare for all Americans?’? No way.”

She was right. Every liberal in the House voted for the healthcare reform bill except for Rep. Dennis Kucinich (D-Ohio), who was undecided days before the vote.

Since the House passed its bill 219-212 last month, more than 40 abortion-rights supporters have threatened to vote against the final healthcare reform bill if it includes the Stupak language. It remains to be seen if they will follow through on this threat, because the Democrats spearheading the effort voted for the measure that passed the lower chamber.

Other threats that have been lobbed at the final bill, should it clear the Senate, have addressed an excise tax on so-called Cadillac health plans, medical liability reform and the inclusion of a public-option “trigger.”