Five Reasons It Might Not Pass
Obamacare still may not be inevitable.


Robert Costa

Harry Reid got his 60. Ben Nelson resorted to the typical Washington expedient in such situations and bought into a few window-dressing compromises, in exchange for an enormous Medicaid benefit to his state. The Cornhusker Kickback joins the Louisiana Purchase as the latest evidence that there’s nothing like a hundred million or so in federal dollars to alleviate a senator’s deeply held concerns about the substance of Obamacare. Nelson’s sellout is a gigantic step toward the passage of the bill, but it’s not over yet. Here are five obstacles that still stand between Reid-Pelosi and a White House signing ceremony:

1. Public Revulsion. The bill was already under water in every major public-opinion poll, and opposed by a margin of almost 2 to 1 in the latest CNN poll. The latest NBC News/Wall Street Journal poll put its support at freezing, 32 percent. A few ticks downward and the bill will be in the 20s.

Is anything that has happened recently likely to change the trajectory? The Reid bill just got even longer, and the new version includes more tax increases. Even by the standards of the United States Congress, the process has been hide-the-children ugly: massive payoffs to the on-the-fence senators and a heedless, late-night rush to pass something, anything. The Democrats have shown no inclination to let public opinion hold them back, but the stiff headwind makes everything a little harder and reduces an already-small margin for error. 

One subset of public opinion will be particularly important: Nebraska. If Nelson is perceived to have made a career-defining choice that will end his designation as a conservative Democrat and a pro-lifer, and if he takes an immediate dive in the polls, it will cast a pall over other Blue Dogs inclined to play ball. In that case, the various payoffs on offer won’t seem worth the larger cost of supporting the bill. It’s too early to tell exactly how it’s going to play in Nebraska, but Nebraska Right to Life has been appropriately excoriating about Nelson’s betrayal.

Democrats have set out to disprove Lincoln’s adage that without public sentiment nothing can succeed. They may yet succeed, but sailing into the teeth of such a howling headwind of public opinion won’t be easy.

2. The Stupak Dozen. Nelson cut a deal so far short of the Stupak language in the House that the National Right to Life Committee is going to score the cloture vote on the bill as a vote to subsidize abortion on demand. That won’t matter to anyone in the Senate, but it could have a major effect in the House. After her initial 220–215 victory, Pelosi can afford to lose only two net votes. Bart Stupak has declared the Nelson language unacceptable and vows to oppose the final bill if it doesn’t include the restrictions contained in his amendment. As John McCormack points out, earlier in the year Stupak was part of a bloc of Democrats who wrote a letter to Pelosi saying they’d stand against “any health-care-reform proposal unless it explicitly excludes abortion from the scope of any government-defined or -subsidized health-insurance plan.” Eleven of those signatories voted for the House bill.

Then there’s Joseph Cao, the Louisiana Republican who voted for the bill at the last moment during the first House vote but has said he would vote against the bill — even if doing so might cost him his seat — if it funds abortion. Surely, not all of the Stupak Dozen have that level of commitment. The full weight of the Democratic establishment will come crashing down on them if they threaten the bill. Still, it would take only two or three of them to upset the entire effort. One option would be simply to give them what they want. But will Barbara Boxer stand for the Stupak language in the Senate? This has been a devilish dilemma for the Democrats from the beginning, and it hasn’t gotten any easier as the stakes have gotten higher.

3. Who Pays? As a practical matter, it should be relatively easy to find a compromise on revenue sources. That doesn’t involve a hot-button cultural issue or a matter of deep principle like abortion. But the differences in financing between the Senate and the House bills are vast. The Senate relies on a so-called Cadillac tax on pricey insurance plans, the House on a surtax on the wealthy. The Senate long ago declared the surtax anathema, and the House is just as dismissive of the Cadillac tax. The unions hate the Cadillac tax, since they enjoy such plans themselves, the fruit of collective bargaining. If the House gives in, it will create even more unrest on the Left. If the Senate gives in, it could upset the fragile deal for 60. If this disagreement over financing doesn’t represent as dire a threat to the future of the bill as the other factors we are cataloguing, it’s still a stumbling block.