The Compromise Blowback: Why Pelosi Doesn't (Yet) Have the Votes for the Senate Health-Care Bill

Speaker of the House Nancy Pelosi fueled speculation of health care's demise when earlier this morning she told reporters, "I don't think it's possible to pass the Senate bill in the House. I don't see the votes for it at this time." Which, for me, raises an interesting question: how is it that Pelosi, with 256 Democrats in her caucus, 219 of whom voted for the bill the first time around, doesn't have the 218 votes she needs to approve the Senate bill?

From what I can tell, the answer is this: among those 256 Democrats, she has a lot of colleagues unhappy with, and unwilling to vote for, the many compromises that their Senate counterparts made.

The Senate bill required a lot of dealmaking to get the whole Democratic caucus on board. In that process, a number of House provisions got watered down or altogether dropped. The Senate nixed the public option and then the Medicaid buy-in when that was causing issues. Their Medicaid expansion and federal subsidies are much smaller. The Senate bill would create less ambitious state-level exchanges rather than the national exchange in the House bill. Senators toned down abortion language, from the very strong Stupak restrictions to a more moderate version crafted by Ben Nelson from Nebraska and Harry Reid. Take a look at the two bills side by side and you'll see the Senate bill is consistently a compromise.

This kind of compromise works well when you're trying to woo a moderate senator like Ben Nelson. But not so much when you want to win over a more liberal House who seem, from most estimates, unwilling to part with their more ambitious demands. It's mostly noted liberals Anthony Weiner of New York, Lynn Woolsey of California and Barney Frank of Massachusetts making the television circuits declaring the Senate bill untenable (Frank, to be fair, walked back on his comments a bit earlier today). None have commented specifically on what exactly they find so objectionable about the Senate bill, but the general sense is that it's just too weak.

This has led to all kinds of pleading from the left for the House just to swallow its pride and vote for the darn bill, given that it's better than nothing. "All you have to do is vote for the Senate bill, as written," TNR's Jon Cohn implored "nervous and frustrated" House Dems in the immediate aftermath of Massachusetts. "Yes, I'm aware of its flaws. But it's also far better than nothing." To which the progressive Democrats have essentially responded: no dice.

But even if Pelosi can get the liberals on board, she faces similar, anti-compromise push back from the social-conservative Democrats. As I wrote yesterday, the toned-down abortion language in the Senate bill would be enough alone to alienate a significant enough number of Democrats as to stand in the way of the bill's passage. As Stupak himself was saying on Fox News yesterday, he's definitely not voting for it and doesn't think it would muster more than 100 votes.

Both of these factions, on their own, present a serious threat to getting the bill out of the House. Pelosi needs 218 votes and, on the first go-around, only had 220 (219 Democrats, 1 Republican). Any defector on any provision—abortion, Medicaid, public option, just take your pick—has Joe Lieberman-like powers to stand in the way. Put them all together and you get a sense of why Pelosi does not have her votes in order.