Health Care Is Going to Overtime

There's nothing more fun than handicapping a vote count in Washington. It’s our version of studying an IPO on Wall Street, or filling out a March Madness bracket on Tobacco Road.

The biggest vote of 2010 is coming up one of these days in the not too distant future in the House of Representatives. It is, arguably, the make-or-break vote of the Obama presidency. It is of course on health care. Last November 7, the House passed a version of the bill by a razor-thin 220-215 margin. A switch of only three votes would have killed it.

Since then, the Senate passed a far different version (with a tax on high-cost health-care plans, sweetheart deals for senators and less sweeping anti-abortion language).  Now the key question is whether the House will accept that version—which would send the measure to Obama. Obama and House Speaker Nancy Pelosi are working on various mollifying “fixes,” which would be voted on later in the House and Senate, either in the “reconciliation” budget process or in a free standing piece of legislation. We don’t yet know precisely what the whole package—that is, the post-vote mollifications—will look like. We are supposed to hear later this week. But the key question is whether there are enough votes to pass the Senate bill.

I’ve spent a good deal of time talking to House leaders, other members and staff. Bottom line: like everything else in American politics these days, this is going to overtime. A member of the House Democratic leadership told me (not for attribution, since they were not supposed to be talking at all), that the chances of passage as of today are “about 45 percent.” That’s not much an expression of confidence. But, they added, “Nancy hasn’t begun to twist arms—which she is good at—and the president hasn’t begun to have one-to-one meetings with wavering members, and he will.”

The first thing to know is that, this time, the Democrats won’t need 218 votes (the normal bare majority, when the House is at its full roster of 435 members), but 216. That is because of four vacancies created by death or retirements, seats that won’t be filled before the vote. Unfortunately for Obama, all three of the now-empty Democratic seats were held by men who voted for the original House bill. The lone Republican retiree voted against. So scratch three votes from the original total of 220 “aye” votes. Scratch another for the sole Republican who voted for the initial House bill, Rep. Joe Cao of Louisiana. He has since said that, without upfront changes in abortion language, he will now vote “no” on the next chance.

With no other shifts, the Democrats have the bare minimum.

But that’s obviously not the end of the story. Based on my survey, there are two categories of November “aye” votes that are now in danger of swinging the other way. One is what I call “double-bind” Democrats—members of the conservative, budget-conscious “Blue Dog” coalition who ALSO voted for strict anti-abortion language that is missing from the Senate bill. By my count there are eight of them: Joe Baca of California, Kathy Dahlkemper of Pennsylvania, Joe Donnelly and Baron Hill of Indiana, Mike Michaud of Maine, Earl Pomeroy of North Dakota, John Salazar of Colorado, and Zack Space of Ohio. Some of these people might be looking for an excuse to get off the bill for fiscal reasons—and they can use abortion as an excuse, an excuse they happened to deeply believe in for good measure.

The other category at risk for Obama are what I call “Blue Dogs in tough places”—people who voted for the original bill but who have seen the home ground turning deeper red. These include Leonard Boswell of Iowa, Jim Cooper of Tennessee, Gabrielle Giffords of Arizona, Charlie Wilson of Ohio, and Brad Ellsworth of Indiana—though the fact that he is now running for the Senate (and needs White House support) might keep him in the “aye” column. In contrast to these categories of risk, Obama and Pelosi have some targets of opportunity, too. One is Democratic retirees, who have not yet left office and who might want to depart after doing a favor for the sitting president—and who can do so without facing the wrath of voters. The chief hope here lies with two Tennessee guys, Bart Gordon and John Tanner (who has said “no” but who is still considered get-able).

Another category I’d call “swing vote/good government types”: a handful of members who consider themselves deeply principled, who voted “no” last time, but who want to be team players. They include Jason Altmire of Pennsylvania, Stephanie Herseth Sandlin of South Dakota, and Mike Ross of Arkansas.

Finally, the “break glass in case of emergency” liberals: at least three lefty Dems who voted “no” last time but who might yield to a personal plea from Obama in a crisis. They include Brian Baird of Washington State, Eric Massa of New York and the surpassingly weird Dennis Kucinich of Ohio. I personally like the Kucinich scenario. It will be fun to watch the president learn to chow down on a strictly vegan diet.