Ten reasons health reform stalled

President Barack Obama’s hope for healthcare reform is in peril, and it’s not all because of Scott Brown’s win in Massachusetts.

The tough spot in which Democrats find themselves is the result of a dozens of decisions made over the past year.

Some of those strategic moves were key in getting the House and Senate to pass their respective health bill. However, the clock was running out – even though few realized it at the time.

{mosads}The many legislative delays left Obama and other party leaders desperately needing a win by what they now say was a weak candidate, Democrat Martha Coakley, to keep 60 Senate seats in Democratic hands and move legislation without GOP support.

The White House knew that it would be difficult to finish health reform in an election and kept pushing Democratic leaders to meet deadlines. In late May, Obama went so as far as to say, “If we don’t get it done this year (2009), we’re not going to get it done.”

If the healthcare reform bill had been completed before the end of last year or if Democrats had retained the late Sen. Edward Kennedy’s (D-Mass.) seat, the same path taken, with all its twists and turns, would be credited for the initiative’s success.

But now that Democrats have lost their 60th vote in the upper chamber and face an electorate dissatisfied with their performance on healthcare, the prospects for accomplishing their healthcare reform goals are considerably dimmed. Some rank-and-file Democrats have gone so far as to call for a return to the drawing board.

A number of strategic and tactical decisions led Democrats to this point. Here are some of them.

Obama. The president made the decision early on to let Congress hash out the details of healthcare, partly because President Bill Clinton’s method of presenting a plan to Congress in the 1990s was a failure. The decision had its advantages, but left Obama above the fray when intra-party spats flared, dragging out the process. Democrats repeatedly asked for Obama to intervene, which he rarely did. A month ago, his hands-off strategy looked brilliant. Not so anymore.

Deadlines. Democrats just couldn’t keep to their self-imposed deadlines. This created a sense of inaction despite the enormous progress made on the bills. All the while, momentum was lost and Republicans were given an opportunity to rally public opposition to the bill. The key to moving controversial legislation is to move it as quickly as possible because bills that linger usually die. The health bills moved at too slow of a pace, allowing critics to pounce.

Messaging. Democrats never united behind a single message to the public. At various times, they sought to sell the bill to the public as a deficit reducer, a consumer-protection bill and a moral imperative. Most recently they cast it as a jobs bill. Marilyn Moon, vice president and director of the health program at the American Institutes for Research, said there are many good things in the bills passed by the House and Senate, but that Obama did not have an effective set of talking points to defend the legislation against GOP critics.

The Republicans. The GOP tore a page out of the 1990s playbook and stood firm against Democratic healthcare reform with near-absolute unanimity, giving Democrats no choice but to assemble a fragile coalition from their own fractious caucus. Just two Republicans, Sen. Olympia Snowe (Maine) and Rep. Joseph Cao (La.), voted at any point for Democratic healthcare bills – and both now stand in opposition.

The economy. As Democrats flailed on healthcare, unemployment rose. Eventually, the economy became a drag on healthcare, as voters questioned why Congress was spending so much time on healthcare instead of jobs. Rep. Paul Kanjorski (D-Pa.) told The Hill on Friday that his constituents for the latter half of 2009 were asking him why Democrats were spending more time on healthcare than the economy.

Climate change. Democrats decided to push a climate change bill through the House before healthcare, against the advice of centrists who felt burned by a politically risky vote on legislation the Senate was unlikely to touch. That made it tougher for House centrists to take another tough vote on healthcare, which dragged out the process further. Before the climate vote, a number of Democrats, including Rep. Chris Van Hollen (D-Md.), the head of the House Democrats’ campaign arm, advised moving healthcare first. Rep. Artur Davis (D-Ala.), a vice chairman of the New Democrats, at the time said “healthcare is where we ought to be putting our emphasis.” Democratic leaders lost political capital with their own caucus with this strategic decision. Davis, who is running for governor, ended up voting against both climate change and healthcare reform.

---

The Gang of Six. Senate Majority Leader Harry Reid (D-Nev.) let Senate Finance Committee Chairman Max Baucus (D-Mont.) spent three months holding meeting after meeting, trying to forge a grand bipartisan compromise on healthcare, even after some Democrats concluded the GOP had no interest in playing along. Again, the process was dragged out, Democrats bickered and they lost time. Much of Baucus’s effort in the end was to win over Snowe, which he did when the bill came to a roll call in the Finance panel. Yet, Reid eventually decreed the efforts to win Snowe’s vote were a “waste of time,” a view long held by frustrated liberals.

The public option. Democratic infighting over government-run health insurance program that would compete with private companies dominated the year, but Democrats never came up with a version that satisfied enough centrists. Obama maintained his support for the idea but liberals saw little evidence that he was fighting for it.

“Backroom deals.” To win a final vote in the Senate with no Republican support, Reid made a deal with centrist Sen. Ben Nelson (D-Neb.) that played badly with House Democrats and the public and made it tougher to reach a final deal with the House. The Senate bill would provide more federal dollars for Medicaid in Nelson’s home state than anywhere else. Former President Bill Clinton in January told House Democrats in January “the Nebraska thing is really hurting us.” Sen. Mary Landrieu’s (D-La.) so-called Louisiana Purchase deal also did not sit well with some Democrats. These side deals,
coupled with Obama’s broken promise to allow C-SPAN to film the healthcare negotiations, hampered the legislation.

The excise tax. The Senate included an excise tax on the highest-cost insurance plans in their legislation, but labor unions vehemently oppose taxing improved benefits negotiated for their members. The excise tax is a main reason why the lower chamber rejected fast-tracking the Senate bill and closing the book on healthcare reform.

Bob Cusack contributed to this report