WASHINGTON — With the struggle over health care entering another difficult phase, President Barack Obama has hit both a milestone and a speed bump in his dual pursuit of a major overhaul of the nation’s medical system and a rebirth of progressivism in America.
House approval of the legislation Saturday — even if Democrats can move it no further — was an accomplishment that has eluded presidents for decades. But the close vote and the exertions it took to secure a majority were laden with warning signs as the issue moves to the Senate.
The health care overhaul was a tougher sell than expected in the liberal-leaning House, and the bill turned out to be more conservative in its price tag, more limited in the scope of its government-run insurance option and tighter in its restrictions on abortion funding than many Democrats had hoped.
Moreover, the narrow victory — 220 to 215 in a chamber where Democrats hold 258 seats — was unsettling for liberals because moderate Democrats have a louder voice in the Senate and Republicans have more delaying power.
What is more, the political climate has become more challenging for progressivism than it was when Obama’s agenda for change was hatched in his 2008 presidential campaign and ratified with his election.
“The joys and the exultant expectations . . . have been mainly silenced by a year of economic turmoil and international uncertainty,” Democratic pollster Peter Hart wrote in a recent memo marking Obama’s election anniversary. “But more striking than the domestic and international struggles is the sense of disappointment and disgust the American public feels toward Washington.”
Shift in public opinion
When Obama was campaigning, public animus toward President George W. Bush was read as a broad mandate for change. Now polls find many independent voters questioning whether Obama is bringing the change they wanted.
A year ago, rising health care costs were at the top of voters’ worries. Now, with unemployment in double digits, jobs are paramount.
“It’s an historic accomplishment, but I’m not sure it’s consistent of the public mood,” Vin Weber, a Republican strategist and former House member, said of the House health care bill.
“The public has shifted in its attitudes toward taxing, spending and the size of deficits in the last eight to nine months,” Weber said.
One telling sign of the shift is that Obama and Democratic leaders have had to lean hard on Democrats to take a vote many saw as fraught with political risks rather than rewards.
“Given the heated and often misleading rhetoric surrounding this legislation, I know that this was a courageous vote for many members of Congress,” Obama said Sunday, “and I’m grateful to them and for the rest of their colleagues for taking us this far. Now it falls on the United States Senate to take this baton and bring this effort over the finish line.”
That line might not be crossed as soon as Democrats had hoped. It looks increasingly likely that a bill will not be ready for Obama to sign until after the New Year holiday.
“It’s too bad the president has to spend all this time trying to rustle up votes within his own party,” said Jim Manley, spokesman for Senate Majority Leader Harry Reid, D-Nev. “But I honestly believe the House vote gives us momentum that Sen. Reid is going to use when he talks to his colleagues about the legislation this week.”
Reid has yet to put the finishing touches on the bill that will be the starting point of Senate debate — a blend of versions produced by two committees.
The Senate bill will have major areas of overlap with the House’s. Both would:
• Expand Medicaid coverage for the needy, provide private-insurance premium subsidies for people of modest means and set rules to make it harder for insurance companies to deny coverage or charge higher rates to people based on their medical status or history.
• Require everyone to have health insurance and set up an insurance exchange to offer affordable policies for small businesses and individuals not covered by employers.
• Include one government-run public option among the choices. However, Reid has said that his bill — in a concession to moderates — would allow states to opt out of offering the government plan.
Senate Republican Leader Mitch McConnell, R-Ky., on Sunday noted that the 39 House Democrats who voted against the bill — mostly conservatives and lawmakers from Republican-leaning districts — represent 1 in 7 Democrats in the House caucus.
“It should serve as a stark reminder that Americans don’t want a 2,000-page, trillion-dollar government experiment,” McConnell said.
Despite the changes made in the House bill to win enough conservative Democratic and anti-abortion votes to pass, the measure is generally regarded as too liberal for the Senate.
“The House bill is dead on arrival in the Senate,” Sen. Lindsey Graham, R-S.C., said Sunday on CBS’ “Face the Nation.”
In both the Senate and the House, centrist Democrats have tremendous leverage over their party’s liberal majority. The threat of losing their votes is what drove House leaders to make concessions on the terms of the public option that liberals did not like — and to allow new restrictions on abortion vigorously opposed by a majority of House Democrats.
Even though that abortion amendment was approved, its opponents swallowed hard before voting for final passage — a show of pragmatism that probably will be required among Senate Democrats as well.
“Getting the best possible bill that doesn’t pass isn’t legislation,” said Rep. Jim McGovern, D-Mass., who opposed the abortion amendment but voted for the bill. “That’s a therapy session.”
