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Senate passes six-month Medicare ‘doc fix’ after late-night deal
By Vicki Needham – 06/18/10 01:25 PM ET
The Hill

Senate Democrats and Republicans reached an agreement and passed a bill Friday that would halt a 21-percent rate cut for doctors.

An accord was reached late Thursday to pass the paid-for six-month Medicare ‘doc fix’ separately to avoid a stoppage in payments, after failing to move forward on a larger tax extenders package Thursday night.

Senate Finance Chairman Max Baucus (D-Mont.) called the development “a good omen” as the Senate attempts to work out the tax extenders bill.
The House will need to pass the measure, which had Republican support when the chamber passed it separately shortly before the Memorial Day recess.

Baucus and the Finance panel’s top Republican Charles Grassley (Iowa) forged the deal late Thursday and presented it to their party members today.

The agreement is to offset the 2.2 percent pay bump for doctors with pension provisions included in the substitute amendment filed by Sen. John Thune (R-S.D.) and a hospital payment provision that was included in the version the House passed before the Memorial Day recess.

A 21.3 percent rate cut for doctors was scheduled to go into effect June 1, and the agency that oversees Medicare has called for a 10-day withholding of payments that also expired.

Obama picks Donald Berwick of Harvard to run Medicare and Medicaid
Tuesday, April 20, 2010; A03
Washington Post

President Obama formally announced Monday his nominee for administrator of the Centers for Medicare and Medicaid Services, fulfilling widespread expectations that he would tap Donald Berwick, a Harvard University professor and leading advocate for improving health-care quality and efficiency.

If confirmed by the Senate, Berwick will play a pivotal — and challenging — role in implementing the recently enacted health-care overhaul legislation. The agency, which is part of the Department of Health and Human Services, must oversee a massive expansion of Medicaid, the federal-state insurance program for the poor, with an estimated 16 million people expected to join its rolls by 2020. At the same time, Medicare, the insurance program for the elderly, will need to reduce payments to health-care providers by about $400 billion over 10 years without impacting the quality of coverage.

Berwick, who specializes in health-care policy and pediatrics, has never led such a large organization. As head of the Boston-based Institute for Healthcare Improvement, however, he is known for persuading doctors and hospitals to adopt innovative methods for reducing medical errors.

– N.C. Aizenman

Groups: DMC sale violates
law

By PATRICIA ANSTETT
DETROIT FREE PRESS MEDICAL WRITER

The sale of the Detroit Medical Center to a for-
profit Nashville company violates state law and
raises issues about whether poor patients who
depend on the DMC will be assured of care for
years to come, three nonprofit Michigan
organizations said today.

Marjorie Mitchell, executive director of Michigan
Universal Health Care Network, said the
organizations e-mailed today a three-page list
of concerns about the sale to Michigan Attorney
General Mike Cox.
Mitchell testified briefly today at the Detroit
City Council about the issue and distributed the
letter. The two other nonprofit organizations
signing the letter were Metropolitan Organizing
Strategy Enabling Strength, or Moses, an
organization of community and religious leaders
active on health issues, and Michigan Legal
Services, a Detroit legal aid organization. The
three groups called themselves the Coalition to
Protect Detroit Health Care.
The groups objected to the proposed agreement
announced March 19 by the DMC to be
purchased by Vanguard Health Systems, a for-
profit firm with 15 hospitals in Arizona, Texas,
Illinois and Massachusetts.
DMC said the sale will bring $850 million for
needed improvements and pay off past pension
and bond debts, in all a $1.5-billion deal in a city
eager for new investments.
Citing a provision in state law, the letter said
Michigan law is clear that nonprofit companies
should not “permit assets … to be used,
conveyed or distributed for non-charitable
purposes.”
The DMC sale has national significance, at a time
when health care leaders wonder if more
struggling nonprofit hospitals will convert to
for-profit status. In Boston, the Caritas Health
System, the state’s second-largest hospital
group, also announced plans this month to be
bought, by New York private equity firm
Cerberus Capital Management, in an $830-
million deal that hospital officials say will allow
the chain to shed debt and make major
improvements.
The DMC sale must be approved by Cox and
hinges on the DMC getting status as a
Renaissance Zone, which gives state and local tax
breaks to companies and residents in exchange
for developments in blighted communities.
[Page 2 of 2]

The Wayne County Board of Commissioners is
scheduled to discuss the Renaissance Zone plan
for the DMC Wednesday. “The county’s initial
due diligence indicates such a transaction can
occur in Michigan,” said Wayne County
Executive Robert Ficano in a statement. Ficano
said he is “sure the Attorney General will review
this $1.5-billion investment objectively.”
Vanguard officials pledge to honor for 10 years
charity care policies of the DMC — Michigan’s
largest provider of safety net care to poor and

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uninsured people — and to not close DMC’s six
acute-care hospitals without board approval.
Mitchell’s organization is one of the state’s most
active groups backing health reforms. She also
was involved in a 1997 Lansing protest that
blocked the sale of a Lansing hospital system to
another for-profit company, a case cited several
times recently as one relevant to the DMC
purchase.
“The mission of a for-profit is to serve the
stockholders,” the letter to Cox said. The letter
said it is the opinion of the three groups that the
purchase by Vanguard of the DMC “violates
Michigan’s nonprofit corporation statute.”
The three organizations asked Cox to hold
public meetings to answer questions about the
impact of the proposed sale on the health of
Detroiters, particularly uninsured people.
The groups also have questions about how the
DMC’s $140-million charitable assets will be
used as well as concerns that use of state
Renaissance Zone money would benefit a for-
profit company.
Mike Duggan, CEO of the DMC, said they have
studied the 1997 case similar to the DMC’s
proposed sale and concluded that, “we did this in
the proper way.”
Duggan said that although the 1977 sale was
blocked, the judge ruled that conversions of
nonprofit hospitals to for-profit could be legal
as long as the nonprofit got the right market
value from the sale. Duggan said he’s confident
the DMC will be able to answer all the questions
raised by the nonprofit organizations.
In a news statement, Cox’s office said: “Under
Michigan law, the Attorney General has a
statutory obligation to review the sale of
charitable assets. To fulfill that responsibility,
the Attorney General’s office has initiated
preparations for a formal review of the sale of
the non-profit Detroit Medical Center. We plan
to examine the transaction carefully and openly,
in order to assess whether Michigan citizens are
receiving their money’s worth.”
Contact PATRICIA ANSTETT: 313-222-5021 or
panstett@freepress.com.
Staff writer John Wisely contributed to this
report.

Sharp momentum shift back to the Democrats after passing health bill
By Alexander Bolton – 03/25/10 08:31 PM ET
The Hill

Political momentum has shifted so fast over the last week that it has given Republicans whiplash.

Democrats are heading into the two-week Easter recess in high spirits after passing the most sweeping domestic policy reform since Medicare was enacted four decades ago.

President Barack Obama on Thursday dared Republicans to make healthcare reform a campaign issue.
“They’re actually going to run on a platform of repeal in November,” Obama said. “Well, I say go for it.”

But even as some Republicans talk of using healthcare as a cudgel, others are questioning the hard-line opposition strategy that limited their input on the substance of healthcare reform and may deny them any chance of shaping financial regulatory reform later this year.

Cracks emerged in the unified front Republicans held throughout most of the healthcare debate. At one point, they had threatened to drag out the final battle over changes to the bill with an endless stream of amendments and budget points of order. But by mid-week, Republicans seemed to lose their appetite for an extended and acrimonious fight. They backed off those threats and allowed the chamber to hold a final vote on Thursday.

“Our constituents expect us to stand up and fight the good fight, but there’s always a reasonableness factor that needs to come into place,” said Sen. Lisa Murkowski (Alaska), vice chairwoman of the Senate Republican Conference. “Sometimes there’s a fine line between what is being an advocate for your cause and when you become obstreperous.

“We need to make sure that we’re always cognizant of that and we push appropriately so but recognize where that line is.”

Senators such as Jim DeMint (R-S.C.) had initially planned to offer scores of amendments to stall the healthcare reform fixes and stop Democrats from putting the finishing touches on the legislation.

By Wednesday, however, the political tone had changed.

“The leadership has asked us to focus on substantive amendments,” said DeMint on Wednesday. “I had 50 amendments, I still have them in my back pocket, but I’ll probably only offer two or three.”

The Senate eventually voted on only one DeMint amendment.

Doubts also spread to financial regulatory reform after Senate Banking Committee Chairman Chris Dodd (D-Conn.) called off negotiations with Republicans. GOP lawmakers then pulled their amendments from the markup and the legislation passed out of his committee on a party-line vote.

“I just think we should have been engaged since October in trying to seek a compromise bill,” said Sen. Bob Corker (R-Tenn.), a member of the Banking panel, in reference to financial regulatory reform. “Once something comes out of committee, you lose a little leverage. It’s one more step along the way.”

For many, the healthcare fight may come to symbolize the tipping point. House passage of broad healthcare reform, which Obama signed on Tuesday, has raised doubts within Republican circles over whether the GOP leadership made a mistake by trying to kill the bill instead of shaping it more to their liking.

Sen. Claire McCaskill (D-Mo.) said GOP colleagues privately expressed weariness with the hardball political tactics that have heightened partisan tensions.

“There have been a couple of [Republican] senators who have said sometimes, like last night, that ‘this is pointless, I don’t know why we’re doing this,’ ” McCaskill said in reference to a voting session that lasted until the early morning hours Thursday to consider GOP amendments to healthcare reform.

Democrats have repeatedly blasted the GOP as the “Party of No” for blocking business in the Senate. At one point earlier this year, Democratic aides said the Senate was sitting on 290 House-passed bills.

Murkowski acknowledged the danger of being labeled by Democrats, because it’s difficult for voters outside the Beltway to follow the intricacies of Senate procedure.

Even so, Republicans are still willing to take a stand on legislation that Democrats believe is broadly popular.

On Thursday afternoon, Sen. Tom Coburn (R-Okla.) blocked legislation to extend traditionally non-controversial provisions, such as unemployment insurance and a freeze in scheduled cuts to doctors’ Medicare payments.

Coburn stopped the package because its cost was not offset and would have added to the federal deficit.

Coburn’s stand is similar to a protest Sen. Jim Bunning (R-Ky.) waged on the Senate floor last month to block an extension of unemployment benefits and other “must-pass” provisions such as the doctors “fix.”

Democrats blasted Bunning and his GOP colleagues for obstruction and claimed a message victory after Republicans backed down and agreed to a short-term extension.

But Republicans also felt they won something from the confrontation, specifically credit among conservative voters for taking a strong position against additional deficit spending.

Even after passage of healthcare reform, which is considered a major victory for Democrats, Republicans haven’t abandoned tough tactics. But some members of their ranks are beginning to show second thoughts.

“Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views?” wondered David Frum, a former speechwriter for President George W. Bush, in an essay published Sunday.

“Too late now. They are all law.”

Obama signs healthcare into law
By Eric Zimmermann – 03/23/10 11:55 AM ET
The Hill

President Barack Obama signed healthcare reform into law on Tuesday, capping a legislative victory Democrats have sought for decades.

“Today, after almost a century of trying; today, after over a year of debate; today, after all the votes have been tallied, health insurance reform becomes law in the United States of America,” Obama said minutes before signing the legislation.

“Here in this country we shape our own destiny,” Obama said. “We have now just enshrined, as soon as I sign this bill, the core principle that everyone should have some basic security when it comes to their healthcare.”

He later added that he was signing the bill for his mother, who he said had battled with insurance companies.

Obama was surrounded by House and Senate leaders and key committee chairmen who had worked on healthcare reform as he signed the legislation. Vice President Joe Biden, Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) were the closest to Obama.
Others in the picture included Senate Majority Whip Dick Durbin (D-Ill.), House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), Senate Finance Committee Chairman Max Baucus (D-Mont.), Rep. John Dingell (D-Mich.), Acting Ways and Means Committee Chairman Sandy Levin (D-Mich.) and Rep. Charles Rangel (D-N.Y.), who stepped down from that committee.

The late Sen. Edward Kennedy’s (D-Mass.) widow Vicki was nearby, as was Health and Human Services Secretary Kathleen Sebelius and White House Office of Health Reform Director Nancy-Ann DeParle.

Scores more House and Senate Democrats were bused to the White House to view the ceremony. Many took pictures to document the moment; before Obama came out for the ceremony, members posed in front of his podium.

When Obama arrived, the audience of Democrats started a “fired up, ready to go” chant that was used during Obama’s presidential campaign.

Obama praised Pelosi and Reid, who hugged one another.

Obama thanked Congress for grinding through the process, acknowledging lawmakers for “taking its lumps” on the issue.

“Yes we did!” an unidentified lawmaker shouted, prompting laughter.

Senate Democrats are still working on a package of adjustments to the legislation Obama signed into law on Tuesday. The Senate hopes to vote on that package by the end of the week, when it would then be sent to Obama for his signature.

Once those changes are made, the law would expand healthcare access to an estimated 31 million Americans at a cost of $940 billion over 10 years. Those costs are to be offset by a series of reforms and taxes, and congressional budget examiners estimate it will cut $138 billion from deficit over the next decade.

Republicans have scoffed at those projections, and outside observers have raised questions over whether future Congresses will go along with reforms intended to reduce the budget deficit.

The House demanded the package of changes as a condition for passing the Senate bill. The legislation is to be considered under budget reconciliation rules that prevent a GOP filibuster.

Obama and his congressional allies chose to highlight the passage of the Senate bill with a ceremonial bill-signing after a grueling year of legislating.

Though liberals in his party have criticized the president for not pushing stronger reform, Democrats largely reacted with a mixture of relief and exuberance to the passage of a bill that was pronounced dead on more than one occasion.

At points in the debate, it seemed possible Obama would repeat the failure of President Bill Clinton, whose ambitious plans for healthcare reform collapsed in Congress. Democrats went on to be crushed in the following midterms.

Democrats hope that the controversy surrounding the current legislation will subside by November, alleviating what they fear could be substantial losses in both chambers.

Some Dems walk plank with ‘yes’ vote
By: Alex Isenstadt
March 21, 2010 07:37 PM EDT
POLITICO

The polarizing health care votes cast late Sunday will have a profound effect on reelection campaigns across the nation, leaving a host of House Democrats—and a few Republicans—to explain or defend a politically treacherous vote that could determine control of the House come November.

Some members of Congress will end up with primary challenges as a result. Others may have signed their own political death warrant.

Here is POLITICO’s rundown of lawmakers whose reelection prospects have been significantly imperiled by their announced support of—or opposition to—health care reform.

The tough-district Democrats

The most immediate blowback from the votes will be felt by Democrats in marginal and conservative-minded districts. They are now assured of being attacked as accomplices to House Speaker Nancy Pelosi, who is not especially popular in many of those districts.

Of these members, many are in their first or second terms, and their path to Washington was greased by strong Democratic years in 2006 and 2008. Now, however, their support for the health care bill will put them in an unfamiliar defensive posture in an already tough year, without a popular Democratic presidential nominee leading the ticket or a GOP majority to campaign against.

Members in this category include Reps. Harry Mitchell of Arizona, Chris Carney of Pennsylvania and Baron Hill of Indiana, each of whom was elected in the 2006 Democratic wave and represents a seat that George W. Bush carried twice.

And virtually every freshman Democrat who won a marginal district in 2008 will need to mount a vigorous explanation of the benefits of a “yes” vote – especially members like Reps. Mark Schauer of Michigan and Dina Titus of Nevada, who won Republican-held seats.

Some veterans – among them nine-term Rep. Earl Pomeroy, who hails from solidly Republican North Dakota, and West Virginia Reps. Alan Mollohan and Nick Rahall – will also feel the heat.

By the time the clock ticked down on the health care vote late Sunday evening, a handful of junior Democrats holding marginal seats had also cast ‘yes’ votes that will be the staple of GOP attacks, including Arizona Rep. Gabrielle Giffords, Wisconsin Rep. Steve Kagen, Florida Rep. Ron Klein, and Illinois Reps. Bill Foster and Debbie Halvorson.

Two first-term women, however, stand out for being in extreme jeopardy: Florida Rep. Suzanne Kosmas and Colorado Rep. Betsy Markey, both of whom went from no on the November health care vote to yes in March and both of whom represent GOP-leaning seats that voted for presidential nominee John McCain in 2008.

After Markey announced her support for the bill last week, the National Republican Congressional Committee immediately blasted out an e-mail labeling her “Betsy Margolies-Mezvinsky” – a reference to former Pennsylvania Democratic Rep. Marjorie Margolies-Mezvinsky, who lost her seat in 1994 after taking a bullet for the party and casting a tough vote for President Bill Clinton’s budget.

Republicans are convinced a handful of vulnerable junior Democrats who have backed the economic stimulus, cap and trade and both health care bills – a roster that includes Ohio Reps. Mary Jo Kilroy and Steve Driehaus, New Hampshire Rep. Carol Shea-Porter and Virginia Rep. Thomas Perriello – are imperiled by tripling down on an ambitious Democratic agenda that hasn’t been completely embraced by their competitive House districts.

“The biggest question for a Democrat in a swing district is, ‘Are you independent of your party and your president?’” said Brad Todd, a GOP media consultant. “And anyone who votes for this legislation is not seen as independent.”

Vic Fazio, a former California congressman who chaired the Democratic Congressional Campaign Committee, said the key for vulnerable Democrats who backed Sunday’s bill was to highlight the benefits of the legislation – and vigorously respond to attacks.

“You have to be very aggressive. You don’t sit back and allow the attack,” said Fazio. “You have to make it the first thing and last thing to talk about.”

“Not everyone will have the intestinal fortitude to do it,” added Fazio. “But every one of these members – including those who voted against [the bill] – will have to explain it to somebody.”

The switchers

Several Democrats in competitive seats will face tough questions about why they supported the bill after opposing it during the House’s first vote in November – a list that includes Kosmas, Markey and freshman Ohio Rep. John Boccieri, who explained his vote in a news conference in front of the Capitol that was televised live on CNN.

On Saturday evening, the NRCC blasted out an e-mail to reporters with the header: “Dems Clap for Boccieri’s Flip-Flop.”

“Members who switched from no to yes will really have the difficulty,” predicted Tom Davis, the former Virginia congressman who chaired the NRCC. “I just think switching from no to yes makes you look like you were strong-armed.”

Larry Sabato, a University of Virginia political scientist, said those Democrats who went the other way – switching from yes in last fall’s health care vote to no on Sunday – will not be able to escape the heat, either.

Members in this category include Reps. Zack Space of Ohio and Michael Arcuri of New York, both of whom represent districts that voted for Bush twice.

“I’ve listened to some of the flippers, and they have very good explanations for their change of heart. Problem is, [Sen.] John Kerry had a good explanation for his: ‘I voted for it before I voted against it.’ Few voters are going to listen to their paragraph-length explanation,” said Sabato.

The upwardly mobile

For those Democrats running statewide in swing or conservative states, there is also risk of political fallout from the health care bill.

In Indiana, Rep. Brad Ellsworth, who is running for the Senate seat left open by the retirement of Sen. Evan Bayh, is already coming under withering attack for his support for the health care bill.

Also bound to face sharp scrutiny for their votes in favor of the bill – though perhaps not as much as Ellsworth – are Reps. Paul Hodes, running for the Senate in New Hampshire, and Kendrick Meek, running for the Senate in Florida.

According to a Public Policy Polling survey conducted this month, 42 percent of Florida voters said they supported the health care reform push, while 50 percent said they opposed it.

Republicans will have a harder time boxing in two House Democrats running for statewide office in conservative states who voted against the bill Sunday: Louisiana Rep. Charlie Melancon, who is running for the Senate, and Alabama Rep. Artur Davis, a gubernatorial candidate who was an outspoken backer of Barack Obama’s in 2008.

The ‘no’ votes

Lost in the focus on the political risk attached to supporting the health bill is the very real downside to voting no.

Arcuri, for one, lost the support of New York’s influential Working Families Party, which vowed not to allow him to run on its ballot line and said it would recruit an opponent to run against him in November.

Freshman Rep. Mike McMahon, another “no” vote who holds a Staten Island, N.Y.-based district that McCain won, is also facing the threat of losing the Working Families Party line. The Service Employees International Union, meanwhile, has signaled that it is open to finding a primary challenger to McMahon; and it’s running a tough ad in the Staten Island Advance targeting the congressman’s vote.

Michigan Rep. Bart Stupak emerged as a “yes” vote after reaching a deal with the White House on Sunday afternoon. But Stupak’s opposition to the bill’s treatment of abortion funding has already earned him a Democratic primary challenge from Charlevoix County Commissioner Connie Saltonstall, who last week won the backing of the National Organization for Women.

Democrats, for their part, are pledging to target a handful of potentially vulnerable Republicans from competitive seats over their opposition to the bill.

Last week, as the votes neared, the DCCC sent out a wave of press releases blasting GOP members including Washington Rep. Dave Reichert and California Reps. Mary Bono Mack and Dan Lungren.

The likelihood of success is much higher for another Republican who ranks high on the DCCC target list: Louisiana Rep. Anh “Joseph” Cao, who voted against the bill despite holding a heavily Democratic, New Orleans-area seat that gave Obama 75 percent of the vote.

House sends Senate healthcare bill to Obama’s desk in 219-212 vote
By Jared Allen and Jeffrey Young – 03/21/10 10:47 PM ET
The Hill

The House made history with the passage of comprehensive national healthcare reform Sunday, giving President Barack Obama a major legislative victory after more than a year of intense debate.

The Senate healthcare bill passed the House a vote of 219-212. Thirty-four Democrats voted against their party, and against the legislation. As expected, the Republican opposition was unanimous.

Less than one hour later, the House approved a package of changes to that legislation that will now be considered by the Senate under budget reconciliation rules that will prevent Republican senators from blocking the bill with a filibuster.

Democrats prevailed on that measure in a 220-211 vote, with 33 Democrats voting no.

Democrats also defeated a GOP motion to recommit the Senate bill, which would have killed the legislation, in a 199-232 vote.

Though the outcome seemed in doubt even as the House convened Sunday morning, as it had at numerous points throughout the past year, House Speaker Nancy Pelosi (D-Calif.) ultimately was able to deliver the votes and further cement her reputation as one of the strongest leaders of the House in decades.

“Imagine a society where someone could change jobs without losing health insurance,” Pelosi said in her floor speech, urging members to support the legislation. “Imagine an economy where people could follow their passions and their talents without having to worry that their children would not have health insurance.”
Pelosi also offered a tribute to the late Sen. Edward Kennedy (D-Mass.): “It wouldn’t be possible to talk about healthcare without acknowledging Senator Ted Kennedy, who made healthcare his life’s work,” she said.

In a 15-minute speech, GOP Leader John Boehner (Ohio) told members they should be ashamed to be approving a bill he said is not supported by their constituents.

President Barack Obama is expected to sign the Senate healthcare bill into law without delay. His signature will allow the Senate to consider the reconciliation bill.
Obama can now lay claim to an accomplishment none of his predecessors were able to achieve. Presidents from Bill Clinton to Richard Nixon to Theodore Roosevelt tried and failed what Obama was able to achieve on healthcare reform.
The Senate, which needs only a simple majority to pass the reconciliation bill, is expected to take up the legislation early this week and pass it only after overcoming Republican procedural delays.

The 34 Democrats to vote against the Senate bill were: Reps. John Adler (N.J.), Jason Altmire (Pa.), Michael Arcuri (N.Y.), John Barrow (Ga.), Marion Berry (Ark.), Dan Boren (Okla.), Rick Boucher (Va.), Bobby Bright (Ala.), Ben Chandler (Ky.), Artur Davis (Ala.), Lincoln Davis (Tenn.), Chet Edwards (Texas), Stephanie Herseth Sandlin (S.D.), Tim Holden (Pa.), Larry Kissell (N.C.), Frank Kratovil (Md.), Dan Lipinski (Ill.), Stephen Lynch (Mass.), Jim Marshall (Ga.), Jim Matheson (Utah), Mike McIntyre (N.C.), Michael McMahon (N.Y.), Charlie Melancon (La.), Walt Minnick (Idaho), Glenn Nye (Va.), Collin Peterson (Minn.), Mike Ross (Ark.), Heath Shuler (N.C.), Ike Skelton (Mo.), Zack Space (Ohio), John Tanner (Tenn.), Gene Taylor (Miss.) and Harry Teague (N.M.)

Sunday’s vote capped of a tumultuous weekend of drama, theatrics, arm-twisting and deal-making, all of which came on top of 20 months worth of legislative debate and maneuvering on the president’s signature domestic policy issue.

The vote in the House did not come easy for Obama and Pelosi, who face the prospect of servere loses in the upcoming mid-term elections.

House Republicans, who bitterly opposed the Democrats’ healthcare reform efforts at every turn, made clear they intend to hammer home their messages against the legislation – and make vulnerable Democrats who backed Pelosi pay at the polls.

The GOP could find some solace in the scene surrounding the Capitol throughout the weekend, as masses of conservative Tea Party protestors convened to demonstrate their intense opposition to Obama and his plans for healthcare. Republicans have also pledged to repeal healthcare reform if they are able to seize control of Congress.
They finally secured the 216 votes they needed late Sunday afternoon when the White House struck a deal with Rep. Bart Stupak (D-Mich.). Eight anti-abortion rights Democrats came on board after the White House issued an executive order clarifying the legislation’s ban on federal funded abortions.

Momentum built for Democrats throughout last week and into the weekend, as more and more members of the caucus announced they would support the bill.

As early as Saturday afternoon, leaders began hinting that they either had 216 votes in hand, or knew that they would secure them by Sunday night.

Democrats immediately basked in their victory, a legislative accomplishment that some of them have waited decades for, and many others came to Congress promising to deliver.

While Obama’s emotional Saturday speech and his administration’s efforts to broker a last-minute deals on abortion and Medicare reimbursement rates brought a critical mass of members into the yes column, Democratic leaders made it clear they believed Pelosi was the driving force behind the bill’s passage in the House.

“This was obviously a huge effort, but it was assisted by the fact that we were hearing stories from constituents,” Rep. Chris Van Hollen (D-Md.) said shortly before the vote of the effort Pelosi put forward. “Doing nothing was not an option.”

“The Speaker had to channel the momentum,” Van Hollen added. “It was either moving forward on this (healthcare) or doing nothing,” he said.

Roxana Tiron contributed to this story.

Pelosi achieves biggest political victory of her career with healthcare reform bill
By Bob Cusack – 03/21/10 10:42 PM ET
The Hill

Nancy Pelosi showed Sunday why she is one of the most powerful Speakers in history.

In shepherding one of the most controversial bills through the House, Pelosi achieved what some thought what was impossible after Scott Brown’s victory in Massachusetts two months ago.

Pelosi’s political stock took major hits at various points in the 111th Congress. Last year, she attracted widespread criticism for her seemingly contradictory statements on what she knew about U.S. interrogation techniques on suspected terrorists. Her handling of the Eric Massa scandal earlier this month was mocked by Republicans and her replacing of Rep. Charles Rangel (D-N.Y.) as Ways and Means chairman was anything but smooth.

Headlines on those issues had some whispering that Pelosi did not have the pull with her caucus that she used to. Some Democrats in the nation’s capital privately predicted Pelosi couldn’t pull off this close vote, especially with more than 30 House Democrats facing tougher reelection races than when the House cleared its healthcare bill last November.

Down at least two dozen votes earlier this month, Pelosi worked many members one-on-one. On Friday, she talked to Rep. Scott Murphy (D-N.Y.) about his vote off the House floor. Hours later, Murphy announced he was going to back the bill.

There were many others.

By leaning on her caucus, Pelosi got a number of yes votes that put her within range of 216. Some of the biggest “yes” votes in recent days were Reps. Henry Cuellar (Texas), Brian Baird (Wash), Bill Owens (N.Y.), Ciro Rodriguez (Texas), Chris Carney (Pa.), Allen Boyd (Fla.), John Boccieri (Ohio), Suzanne Kosmas (Fla.) and Betsy Markey (Colo.).

Pelosi did make some wrong turns along the way, including considering using the so-called “deem and pass” strategy of passing the bill. The mulling of “deem and pass” proved to be a massive distraction, quickly becoming the focal point of the media’s coverage of the bill.

Several Democrats, including Rep. Dennis Cardoza (D-Calif.), vowed to reject such a procedural ploy.

Like she has many times before, she listened to her caucus. She then pivoted, opting against employing the tactic. Cardoza, who is a member of leadership, voted yes.

While several Democratic leaders boldly claimed they had the votes earlier this week, Pelosi knew she was still a significant amount shy. One of the best vote-counters in Congress, Pelosi was forced, once again, to strike a deal with Rep. Bart Stupak (D-Mich.).

It was an eleventh-hour deal that could have cost “yes” votes from abortion-rights Democrats. But Pelosi, a staunch supporter of abortion rights, convinced them that unless Stupak was on board, the bill would die on the House floor. They quickly got in line.

Certainly, Pelosi had a lot of help in passing the healthcare bill, most notably from President Barack Obama, Majority Leader Steny Hoyer (D-Md.), Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) and Majority Whip James Clyburn (D-S.C.).

Obama personally urged dozens of Democrats to vote yes, and while some refused to budge, others moved into the “yes” column.

But no one knows the House Democratic Caucus better than Pelosi.

And publicly, she never hinted how far she was down in the votes.

“I have faith in my caucus,” Pelosi said earlier this month.

Pelosi has had a lot of experience in winning close votes.

She muscled a climate change bill through the lower chamber last year, 219-212. Months later, after a deal with Stupak, the House healthcare bill passed, 220-215. The Speaker also has finessed tought-to-pass war supplemental bills through the House.

This healthcare bill was the toughest lift. Centrists didn’t like it because many of their constituents were telling them it was a bad bill. Liberals didn’t like it because the legislation came from the Senate — a chamber they don’t trust and now openly belittle.

Along the way, Pelosi had to make sacrifices. After pushing hard for the public option throughout 2009, Pelosi was forced to abandon it this year. She also had to swallow most of the Senate bill while bending on the abortion provisions.
Republicans scoff at the notion that passing healthcare reform is a win for Pelosi and the Democratic Party, pointing to Brown’s win and the looming election when many Democrats are expected to lose.

Rep. Mike Pence (Ind.), chairman of the House Republican Conference, told his colleagues on Saturday that victory — one way or the other — would be theirs. That triumph would either come during the third Sunday of March or the first Tuesday in November, which is Election Day.

Still, Republicans privately admit they underestimated Pelosi when she took the gavel in January, 2007. Defying their predictions back then, Pelosi charted a cautious chart in her first year as Speaker, wary of endangering her majority.

As GOP poll numbers plummeted further, Pelosi adopted a more aggressive leadership style in 2008.

With Obama in the White House, Pelosi moved left, moving the climate change bill before healthcare reform. That decision irritated politically vulnerable Democrats and some in the Obama administration. The climate bill is considered dead in the Senate.

At the end of 2009 as the political winds shifted to the Republican Party, Pelosi attempted to put her caucus at ease. Saying she was in “campaign mode,” Pelosi vowed she would no longer move controversial bills until the Senate acted first.
Pelosi has long said climate change is her flagship issue, but it is unclear whether that measure will pass while she is Speaker.

It is clear, however, that her legacy as Speaker will be forever tied to healthcare reform.

CBO: Health package costs $940 billion; Hoyer says vote will come on Sunday
By Michael O’Brien and Jared Allen – 03/18/10 09:21 AM ET
The Hill

Democrats are lauding a CBO report that found their healthcare package will cut the deficit by $130 billion.

House Majority Leader Steny Hoyer hailed the figures from the non-partisan Congressional Budget Office during a meeting with a group of reporters on Thursday morning and said the House would vote on Sunday.
He said House Democrats had crafted a bill that would amount to the largest deficit reduction package in more than 15 years.
“We think the numbers are now pretty well set from CBO,” Hoyer said. “We think it will post the largest deficit reduction of any bill that we’ve adopted in the Congress since 1993.”

CBO told lawmakers that the health package would cost $940 billion over the next decade, reducing the deficit by $130 billion over the next decade. It will cost $1.2 trillion in the second decade of the plan’s implementation.

That’s more expensive than the healthcare measures passed by both the House and the Senate last year, though the CBO said the current bill would make larger reductions in the deficit.

An official score from the budget office is expected around noon, but reports about the findings were leaked to the press before the formal release.

“We are absolutely giddy” about the score, said Majority Whip James Clyburn (D-S.C.) said during an interview on Fox News Thursday. About the deficit reduction figures, he added “This is great news for the American people.”

Hoyer said the CBO score will show the final bill to reduce the deficit by over $1 trillion over the second decade of its implementation.

Democrats have been waiting for the CBO score for days, and several undecided lawmakers have said the CBO findings will influence their votes. Leaders need 216 members of their caucus to support the healthcare package for it to win passage.
The package considered by the CBO is the Senate healthcare bill and a package of changes to that legislation that must receive votes from the House and Senate.

House leaders are considering the use of a controversial rule that would “deem” the Senate bill as having been passed without an actual roll call vote on the measure.

The process would send the Senate healthcare bill to President Barack Obama, with the package of changes to the bill going to a vote in the Senate under budget reconciliation rules to prevent a GOP filibuster.

Hoyer said the amendments to the Senate healthcare bill – which, along with student loan legislation, make up the reconciliation bill – have been projected to reduce the deficit by $120 billion in the first 10 years, outpacing the $100 billion estimate of the original bill.

The release of the CBO score sets into motion a 72-hour endgame on healthcare. Leaders have said they will give members 72 hours to review the legislation before a vote.

House Republicans are set to offer a measure today that seeks to force and up-or-down vote on the Senate healthcare bill.

This story was updated at 9:45 a.m. and 10:15 a.m.

Months after last health vote, many Dems in tougher reelection races
By Bob Cusack – 03/15/10 08:34 PM ET
The Hill

Thirty-two House Democrats are in tougher reelection races than they were when the lower chamber passed healthcare reform last fall.

Thirty-two House Democrats are in tougher reelection races than they were when the lower chamber passed healthcare reform last fall.

The gloomier political climate for Democrats has made it more challenging for Speaker Nancy Pelosi (D-Calif.) and her lieutenants to attract the 216 votes necessary to pass a health reform bill this month.

Seventeen Democrats who were not on the radar screen of campaign handicappers in November are now in competitive races, according to the nonpartisan Cook Political Report.
Meanwhile, the races of 15 Democrats have become tighter, increasing the chances the GOP could win them.

Of the 32 Democrats, 25 voted in favor of the House healthcare bill on Nov. 7.

Earlier this month, President Barack Obama said, “I don’t know how [healthcare reform] plays politically, but I know it’s right.”

While Obama is not up for reelection this year, congressional Democrats are clearly weighing the political impact of their votes in the 2010 midterms.

The latest Gallup Poll found 48 percent opposed Obama’s healthcare proposal.

Rep. Alan Mollohan (D-W.Va.), considered a heavy favorite to win his seat last fall when he voted yes, is now in a toss-up race. Mollohan has not said how he will vote this year.

The reelection races of Democratic Reps. Baron Hill (Ind.), Mark Schauer (Mich.), Dina Titus (Nev.), Carol Shea-Porter (N.H.) and Glenn Nye (Va.) have moved from the lean-Democratic column to tossup since November. Of these five Democrats, only Nye voted no last year.

David Wasserman of the Cook report noted that GOP candidate recruitment has intensified significantly from last November.

Only three Democrats who were deemed to be in competitive races in the fall have seen their reelection chances improve, according to the Cook report.

Rep. Bobby Bright (D-Ala.) has gone from being in a toss-up race to being in the lean-Democratic category. As Republicans have struggled in recruiting a top-notch candidate in North Carolina’s 8th district, Rep. Larry Kissell (D-N.C.) has been upgraded from the lean-Democratic category to likely-Democrat. And Rep. Peter DeFazio (D-Ore.), who was being targeted by Republicans earlier this cycle, is now expected to cruise in his reelection bid.

Bright and Kissell, however, are firm “no”s on healthcare reform. They both opposed the House bill in 2009. Wasserman noted that Bright and Kissell do not toe the party line, adding that Bright is viewed as a nonpartisan legislator and Kissell has a reputation of being an outsider.

The Hill’s whip list on healthcare has 37 Democrats planning to vote no or are likely to vote no. Thirteen of the 37 are not on Cook’s House competitive race list. One of them, Rep. Marion Berry (Ark.), is retiring, and two other “no” votes, Reps. Artur Davis (Ala.) and Charlie Melancon (La.), are running for higher office.

The other 10 are Reps. Dan Boren (Okla.), Jerry Costello (Ill.), Luis Gutierrez (Ill.), Dennis Kucinich (Ohio), Daniel Lipinski (Ill.), Jim Matheson (Utah), Mike McIntyre (N.C.), Collin Peterson (Minn.), Bart Stupak (Mich.) and Gene Taylor (Miss.).

There are dozens of Democrats who are publicly undecided, according to The Hill’s whip list, and more than half are in competitive reelection races.

Some Democrats looking over their shoulders, such as Reps. Alan Grayson (Fla.), Tim Walz (Minn.) and Bruce Braley (Iowa), are expected to vote yes.

Many non-incumbent Democrats running for Congress also are skeptical. The Hill last week reported that of the 26 leading Democratic House candidates, only one would commit to voting for the Senate healthcare bill if and when it comes to the House floor.