Democratic Sen. Ben Nelson thought he’d struck a deal that would please Nebraskans and give him cover for helping push his party’s health care overhaul over its biggest hurdle to date.
But his state’s voters still don’t like the bill and are embarrassed by the $100 million in special Medicaid payments he secured for Nebraska, leaving the embattled senator with a bigger bull’s-eye on his back as Republicans and groups that oppose the overhaul search for converts.
Senate Democrats need to keep all 60 members of their caucus on board to pass a bill. House Democrats had a slim three-vote margin for their health care bill, turning every lawmaker into a potential make-or-break vote and spotlighting a list of potential defectors.
California Gov. Arnold Schwarzenegger, a Republican, upped the pressure last week in his state of the state address. He told California’s congressional delegation to secure “the same sweetheart deal” on Medicaid as Mr. Nelson got for Nebraska, or else vote against the bill.
“Health care reform, which started as noble and needed legislation, has become a trough of bribes, deals and loopholes,” the governor said. “You’ve heard of the bridge to nowhere. Well, this is health care to nowhere.”
In the House, which will resume work Tuesday, Republicans have listed 37 Democrats who they think are vulnerable to political pressure on the issues of Medicare funding, abortion and the federal budget. The list includes several Democrats in moderate districts who could face difficult re-election fights.
“If we can convince enough of these 37 members (along with the 39 Democrats who already voted no) to reconsider and switch their position on the bill, I know that we can defeat this government takeover of our health care before it becomes law,” Minority Whip Rep. Eric Cantor of Virginia said in a memo to Republicans.
He listed 18 Democrats who have a significant number of constituents enrolled in Medicare Advantage, whose funding would be cut under Democrats’ plans. Mr. Cantor also pointed to 11 Democrats who he said might be forced to vote against the bill if a pro-life amendment that the House adopted is weakened in a final compromise.
If three Democrats switch their position, the bill will be defeated. The National Republican Congressional Committee has started targeting many of their districts with analyses showing how the bill would hurt their constituents.
House Democratic leaders are trying to hold together at least 218 votes, despite disagreement over how to pay for the bill. They largely oppose the Senate’s method, backed by President Obama, that would tax high-valued insurance plans.
“The president has always been in favor of the excise tax,” Rep. Frank Pallone Jr., New Jersey Democrat, said Thursday on his way to a Democratic caucus call. “The question is whether or not it’s in there or it’s pared down in some way and replaced in part with some of the House ‘payfors,’ particularly with the surcharge [on wealthy Americans].”
Many of the liberal advocacy groups that once spent their time and money supporting the reform effort in general have shifted gears and now are focusing on getting their particulars through the conference.
Health Care for America Now is spending $400,000 on television advertising highlighting the benefits of the House’s health care bill and in particular opposing taxes for any health care plans.
“The bill creates shared responsibility among individuals, employers and government to ensure that all Americans have affordable coverage of essential health benefits,” the ad says. “And we won’t pay a tax on our health benefits.”
The AFL-CIO is hosting a “call-in” day to organize members to ask lawmakers not to tax the high-valued plans, which they say will hit many of their union members.
The American Future Fund, a conservative advocacy organization, says it will continue to try to gather grass-roots opposition to the Democrats’ health care reform bill.
“So many things get turned around when elected officials are home on holiday and when people have access to them,” said Sandy Grenier, president of the American Future Fund.
In the Senate, a few moderates who were initially reluctant to support the health care bill likely will face pressure to oppose the final measure. They include Sen. Joe Lieberman, Connecticut independent; and Democrats Sens. Mary L. Landrieu of Louisiana, Blanche Lincoln of Arkansas and Mr. Nelson.
Ms. Lincoln is heading toward a difficult election this year, and the health care issue hasn’t helped. A Rasmussen Reports poll conducted Jan. 5 found that Ms. Lincoln would lose the race when matched against four Republicans who have been mentioned as opponents. It also found that 51 percent of Arkansans “strongly oppose” the health care reform bill.
Lawmakers have a series of issues to sort out in the House and Senate bills, including how to pay for it, whether to establish a national or multiple state-based health exchanges, and how to deal with abortion language.
The House’s plan has severe limitations designed to prevent taxpayer funding of abortions — which was included in a last-minute attempt to maintain the support of Democrats who oppose abortion rights. The Senate plan isn’t as restricted — it requires patients to pay for abortion coverage separately from any taxpayer subsidies — but groups that support abortion rights don’t like it either.
Democrats in both chambers have said they want to remove the Medicaid benefit that Mr. Nelson worked into the bill. Last week, Mr. Nelson said he asked Democratic leaders to give all states the same benefit or allow them to opt out of expanded Medicaid coverage.
A spokesman for Mr. Nelson said his new request isn’t in response to political pressure at home, where even the state’s Republican governor has protested the extra funding. Instead, Mr. Nelson hoped to insert the funding to give him leverage to expand it at conference, his spokesman said.
“I’ve been in serious discussions with Senate leaders and others to secure changes in the bill to treat all states equally,” Mr. Nelson said in a statement. “At the end of the day, whatever Nebraska gets will apply to all states.”