Forget the Senate, House Hurdles Threaten to Sink Health Reform

Cost control, abortion, taxes, and regretful House Democrats could sink the bill.


Linda Killian, Thomas Jefferson Street blog

There's been endless talk about counting votes and using reconciliation to pass healthcare in the Senate. But with the realization that the Democrats probably don't have a majority of votes for the plan in either chamber of Congress right now, attention is shifting to the House.

House members feel a little bit like Charlie Brown with the football expecting the Senate/Lucy to pull it away just as they are ready to kick it. That's why there is some complicated back room choreography going on about who goes first.

But according to Jason Altmire, a moderate Democrat from Pennsylvania's 4th District, the order doesn't matter. What matters is what's in the bill.

Altmire voted against the House plan in November, and he says he hasn't seen or heard anything since to convince him to change his mind.

"I don't think that anything has changed. We're hearing the same talking points we've been hearing for a year. I don't think the debate has moved one way or the other," Altmire says.

In order to pass health reform, House leaders not only have to persuade someone like Altmire who voted no to switch his vote, but also hold on to all of the yes votes they had the first time.

A number of his colleagues who supported the House version of health reform "deeply regret their vote" because of what they are hearing from their constituents back home, Altmire says. "I know some who would love the opportunity to make up for it" by changing their vote the second time around.

"At least a handful of them would relish the opportunity to have a do-over," predicts Altmire.

On top of that, add the abortion funding issue which is forcing Democrats to thread the needle in an attempt to keep everyone happy on both sides of that debate and could cost them some votes.

"In that dynamic where you are almost certainly going to lose some yeses, I don't see where you are going to make up the difference," says Altmire. He said he doesn't know anyone who voted no in November who would change their vote unless the legislation was substantially changed.

What it would take to win his vote is addressing spiraling healthcare costs, which he says the Democrats seem to have lost sight of.

"I personally need to see more cost containment and delivery system reform. Right now they are just shifting money around," Altmire says. "The debate started there--with reducing the cost for people who have insurance now--but it evolved into a social engineering initiative to cover everybody and raise taxes to do it."

Not exactly the sound bite Democrats would want to see featured in a commercial about their health plan.

But Altmire has some pretty impressive company who share his feeling about the plan. Business guru Warren Buffett on CNBC Monday expressed much the same view, saying the current bill does not focus on controlling costs, which is the central problem that must be addressed to reform the system.

"What we have now is untenable over time," said Buffett, who was an Obama supporter. "That kind of a cost compared to the rest of the world is really like a tapeworm eating, you know, at our economic body."

"We have a health system that, in terms of costs, is really out of control," he said, adding that the rise in healthcare costs is seriously affecting the ability of the U.S. to be competitive.

Since the Senate bill "really doesn't attack the cost situation that much", Buffett said he would favor scrapping it.

Perhaps not surprisingly, Altmire says his leaders have not reached out to him seeking his support.

"I don't think they have decided what strategy they are going to pursue in this go around," he says.

An aide to another moderate House Democrat who voted yes the first time said her boss is getting so tired of the whole healthcare debate he would vote yes again just to make the whole thing go away so Congress can focus on jobs.

Maybe that's the argument Democratic leaders should use when they're lobbying for votes. 

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