Anatomy of a Health Reform Deal

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Don’t the Democrats control Congress? How did Nancy Pelosi get to the point where she didn’t have enough votes in her own caucus to pass health reform unless she paved the way for language that, as Jon Cohn puts it, “mak[es] it more likely that millions of American women will no longer be able to purchase insurance that covers abortion services”?

Some liberals will complain that this is what Democrats get for recruiting more socially conservative candidates to run in red districts. But not all pro-life Democrats are the same. Someone like Tim Ryan from Ohio who has worked to find common ground on abortion and will vote for health reform whether or not the Stupak amendment passes is not like Bart Stupak, who represents a district so Republican that as one of his pro-life colleagues once told me, “Bart simply couldn’t win without the endorsement of the National Right to Life Committee. So he has to end up taking a much harder line than the rest of us do.”

What’s surprising to me is that so many of Stupak’s Democratic colleagues stood alongside him in opposing the Democratic proposal unless it included an unprecedented strict standard regarding what constitutes federal funding of abortion. As I’ve written before, I think some pro-life groups and the Stupak faction moved the goalposts throughout the summer and fall in terms of what they would accept in terms of abortion language. 

But it also seems clear that the Democratic leadership and White House dropped the ball on finding a compromise with pro-life Democrats. The deal reached late last night/early this morning in the Speaker’s office is not a compromise; it is in fact more than the Catholic bishops and Stupak himself asked for as late as mid-summer. The Speaker didn’t get rolled by crafty or stubborn members of her party, though. This was a predictable consequence of a high-handed approach to dealing with pro-life members of the Democratic caucus.

Despite the fact that anyone who has followed U.S. politics over the last thirty years could have told you that abortion would be a controversial aspect of health reform, no one tried to preemptively address the concerns of pro-life Democrats by sitting down with them early in the process. The White House didn’t reach out to some of the more good-faith players on the pro-life side until early September. And Pelosi didn’t sit down with Stupak until September 29. This despite the fact that 19 Democratic members sent her a letter in June expressing their concerns with abortion coverage in health reform.

I know many in the Democratic caucus tend to see their pro-life colleagues as a pesky but ultimately insignificant faction. But this sort of leadership strategy isn’t just inexcusable, it’s malpractice. It appears that Pelosi thought Stupak et al were bluffing and would come around in the end rather than oppose health reform. That assumption also depended on a scenario in which the Catholic bishops may not have supported health reform but also didn’t vigorously oppose it.

It became very clear by late last week that this assumption was a mistake. Instead of staying neutral or remaining quiet about their concerns, the US Conference of Catholic Bishops launched a grassroots campaign to oppose health reform, sending out bulletin inserts and fliers to every diocese in the country and urging priests to speak out from the pulpit last Sunday. In addition, every bishop was urged to contact the congressional members in their diocese and insist that they vote against health reform. And when the Democratic leadership whipped the bill late this week, they found they didn’t have the votes to pass it. Which is how Stupak and representatives from the USCCB ended up in the Speakers’ office last night and emerged with a deal that gives them everything they wanted.

It’s hard to know for sure, but my best guess is that it didn’t have to come to this. After having their concerns ignored through consideration of health reform in the House Energy and Commerce Committee this summer, pro-life Democrats decided that the Capps amendment–which was intended to eliminate any pro-life objections–didn’t go far enough. Pro-choice leaders and the Democratic leadership, however, treated the Capps language as the ultimate concession. When pro-life Democrat Brad Ellsworth tried to break the stalemate with a relatively weak version of the Stupak amendment last week, pro-choice groups fought his effort. Looking at the Stupak amendment about to become part of health reform, they may wish they had the Ellsworth language instead.

Perhaps the best way to have headed off this debate in the first place would have been to make sure that the original health reform legislation was not introduced with language that could have allowed direct federal funding of abortion. That starting point signaled to pro-life Democrats–rightly or wrongly–that their colleagues hoped to use health reform to change the status quo regarding government funding of abortion. And the fact that their concerns went unacknowledged for months from both the White House and House leadership seemed to confirm their fears.

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