Will Democrats Pass Affordable Health Insurance Reform?

The fight over healthcare reform has reached the Senate, and may take longer than previously expected. Reform intended to promote the wider availability of affordable health insurance seems to have lost the momentum recently gained via its nail-biting passage in the House of Representatives. Republican senators have expressed unanimous disapproval of the bill and vow to filibuster in order to block it. Healthcare reform will require 60 votes to pass, which means that the entire Democratic caucus–the party’s entire Senate delagation with a handful of independents–needs to support it. Senate Majority Leader Harry Reid is attempting to hold together two divergent wings of the Democratic caucus, with several factors coming into play.

As it currently stands, the health care reform bill isn’t ideal for either liberal or conservative Democrats. While Democratic leaders have encouraged passage under the logic of imperfect reform being preferable to leaving the current system as it stands with soaring health insurance rates, many senators are understandably leery of voting for legislation that will take a monumental effort to amend later. Reid is doing his best to convince Democrats, as well as Democratic sympathizers, that this is a rare opportunity that shouldn’t be passed up. Whether he will manage to bring them around to his viewpoint remains to be seen. President Obama has also pushed for a completed bill on his desk before January, although that possibility is becoming more and more remote. Obama has several major priorities on his plate (both domestic and foreign) besides healthcare reform, and is currently suffering from lower popularity ratings. Therefore, his influence is probably more decreased than many once thought.

One of the most controversial aspects of healthcare reform is the public option, which would create a federal government-run alternative to private health insurance plans. Proponents claim that it would drive down the cost of health care through using its buying power and regulatory muscle to buy health care services at lower rates, while at the same time forcing for-profit health insurers to lower their health insurance premiums to stay competitive. They predict more affordable health insurance as the result. On the other hand, opponents decry the increased level of governmental involvement and potentially deficit-busting cost of a public option. The former group consists of liberal progressives, such as independent Vermont Senator Bernie Sanders and Democratic National Committee chairman Howard Dean. Sanders, in particular, is threatening to vote against a bill that lacks a public option. Those in the latter group, including Ben Nelson of Nebraska and Connecticut’s independent Joe Lieberman, have expressed their willingness to jump ship and vote against a healthcare reform bill that includes a public option.

The Democratic caucus appears to have reached an impasse in some respects. A compromise currently proposed in the Senate allows individual states to opt out of the public option. Liberals seem to begrudgingly accept the clause, but it isn’t good enough for staunch fiscal conservatives like Lieberman and Nelson. Due to the Democrats’ razor-thin majority in the Senate, Reid can’t afford to lose a single vote. The chances of garnering Republican support for this healthcare reform bill are slim to none. The only hope of doing so is through writing a trigger function into the bill. Such a measure would only enact a public option if certain goals of expanding affordable health insurance to more Americans are not met. There may be a handful of Republican moderates like Maine Senator Olympia Snowe willing to vote for such a measure, allowing for a cushion in the event that Lieberman bolts; but that gamble has the possibility of angering progressives.

In the recent past, liberal Democrats tended to hold their nose and vote for legislation they had serious issues with because it was preferable to the alternative of getting even less of what they wanted; now, they are becoming more outspoken, threatening to withhold their votes if provisions regarding the public option or abortion are unacceptable to them–using the same tactics conservatives on both sides of the aisle have used to pressure party leaders in the past. It will be a significant struggle to keep all of the Senators in line. The bill is still being written, but Reid appears to be supporting a moderate approach that, by its definition as a comprehensive healthcare reform bill, leans more towards centrist and liberal Democrats but still has too many flaws for them to endorse wholeheartedly.

The chances of healthcare reform soon passing the Senate are mixed. Michigan Senator Carl Levin believes that the bill stands a “decent chance” of gaining the 60 votes needed to break a filibuster. Indiana’s Evan Bayh seems to be similarly ambivialent, though he admits that a solution that satisfies everyone is virtually impossible. Meanwhile, Republicans are calling the bill fatally flawed and recommending that it be scrapped and healthcare reform put on the back burner. That idea is unacceptable to Democrats, who believe that increasing access to affordable health insurance is essential to their larger economic recovery effort. Moreover, they probably want to have some legislation to show their constituents before the 2010 midterm elections. If the Senate manages to pass the bill, its version will need to be combined with the House’s version. In the event that the combined bill is approved by both chambers of Congress, it then goes to President Obama’s desk. While it is doubtful that he would veto a bill regarding one of his highest domestic priorities, one that strays too far from its indended purpose has the small chance of not receiving a signature.