Massachusetts to Determine Health Care Reform? How Fitting.

After all the policy debates, lobbying, letter writing, political infighting, town hall meetings, cable news show histrionics (let alone nonsense), fear mongering, hyperbole, overpromising, committee hearings, academic musings, back room negotiations, blogging, twittering, spam emails, rallies, and even, on occasion, thoughtful and civilized discussion, the fate of health care reform all comes down to a special Senate election in Massachusetts. No scriptwriter could get away with this plot twist. The audience wouldn’t buy it.

But tomorrow, November 19th, voters in Massachusetts determine whether health care reform will pass. Pretty much. Yes, there are ways Democrats can overcome a win by the Republican candidate, state Senator Scott Brown. They might recruit a moderate Republican in the Senate to join them in passing their legislation. But as there are really only two moderate Republicans left in the Senate (both from Maine) that’s a long shot.

They could ram through legislation before the election results are certified, but that will hand Republicans a huge stick to wield in other 2010 elections. Democrats in the House could simply approve the health care reform bill passed in the Senate, but there’s plenty in the Senate bill to give House members up for election this year heart burn.

On the other hand, even if the Democratic candidate, Attorney General Martha Coakley, manages to win tomorrow, there’s no guarantee health care reform passes. But as I’ve written recently, with 60 Democrats in the Senate passage of a comprehensive health care reform bill is not inevitable, but it’s certainly likely.

So what happens in Massachusetts tomorrow matters. A lot.

Voter turnout will be the key to determining the outcome of the special election. Which is why both parties are pulling out all the stops to get their voters to the polls. One challenge for Democrats is that, although they outnumber Republicans in the state 3-to-1, the majority of voters (51 percent) are unaffiliated with either party. And they are supporting Senator Brown.

A single state having enormous influence on American politics and policies is not unusual. Iowa and New Hampshire have a tremendous impact on who emerges as the party’s presidential nominees. And why shouldn’t Massachusetts have a big say concerning health care reform? As a reader of this blog, Jim Hicks, noted in an email, they’ve been living under their own reform plan for the past few years.

How fitting. Unbelievable, but fitting.

Health Care Reform Not Inevitable, But Still Likely

Passing major health care reform was never going to be easy. The issues are hard. Partisanship in Washington has rarely been greater. The status quo may be a road to disaster, but it’s a familiar road. Moving America’s health care system in a new direction is a Herculean task. Yet for the past year or more, most observers considered passage of some legislation a better than 50/50 proposition. Now, with negotiations over reconciling differences between the Senate and House versions of reform bills comes down to the wire, what are the chances of Congress passing a bill President Barack Obama will sign into law?

According to the Associated Press, House Republican leader John Boehner is claiming that Speaker Nancy Pelosi may not be able to push health care reform through their chamber. He maintains that “dozens” of Democrats who supported the bill passed by the House in November could turn against the final bill, especially if the there are significant changes to provisions dealing with abortion, aid to the states to pay for Medicaid expansion and Medicare cuts.

The outcome of the Massachusetts Senate race to replace the late Senator Edward Kennedy could also result in some Democrats reconsidering their willingness to go along with this version of reform. Not long ago the conventional wisdom was that winning the Democratic primary in Massachusetts was tantamount to election. However, recent polls show the the Democratic nominee, the state’s Attorney General, Martha Coakley, in a dead heat against Republican State Senator Scott Brown within two percentage points of the Democrat. Special elections are always difficult to predict because turnout is usually so low. Were Senator Brown to win the election on January 19th it would not only deny the Senate Democratic caucus the 60 votes they need to push health care reform through the upper house, but it would make moderate Democrats in Congress recalculate the political price of supporting the current version of reform.

Senator Brown doesn’t need to win the seat to scare Democrats. The race has been described by the media as a proxy on health care reform. Republicans are pointing to the Massachusetts Senate race  to bolster their argument that they can retake Congress in the upcoming elections. While that might be wishful thinking, it certainly would make obvious the political reality that Democratic majorities in Congress will be smaller next year than they are this year.

All of this is some evidence that health care reform could be in trouble. My opinion: passage of health care reform is more likely now than it was in December. Here’s why:

First, Senate Majority Leader Harry Reid, Speaker Pelosi and President Obama are closer than ever to an agreement. "’Prospects of reaching agreement between the Senate and the House are better than they were 24 hours ago. We’re getting close,’ the Associated Press reports House Majority Leader Steny Hoyer saying on Tuesday. Finding a compromise that will earn 218 votes in the House and 60 in the Senate is not inevitable, but it’s doable. And with President Obama more personally involved in the health care reform negotiations now than he has been in the past year, the chances of finding that combination of trade-offs is closer than ever.

Second, by emphasizing what’s at stake in the Massachusetts Senate race, Republicans have mobilized Democrat voters in the state. That’s the point made by E.J. Dionne in a Washington Post blog. Instead of staying home next Tuesday, counting on the inevitability of Attorney General Coakley’s pre-ordained victory, Massachusetts Democrats know they have to get to the polls. And they are likely to do so.

There are other tea leaves increasing the likelihood of a health care reform bill becoming law in the next few weeks. Senator Reid made some fairly obvious deals to get the 60 votes he needed to move health care reform out of the Senate. The most egregious was promising to pay Nebraska’s increased Medicaid costs in perpetuity at the request of Senator Ben Nelson. Republicans jumped all over that deal. Even the Republican Governor of Nebraska attacked the deal.

Well, fine. Senator Nelson can now head back to Nebraska and show he fought hard for the state, but Governor Dave Heineman killed the deal. (At the moment, Senator Nelson is calling for all states to get the same Medicaid relief as he negotiated for his own state). Yet Senator Nelson is still likely to support whatever health care reform bill emerges from the current negotiations, unless the abortion language is significantly weakened. What else can he do, proclaim that unless Nebraska gets a windfall he’ll torpedo reform for the rest of the country? So what’s likely to happen is that the GOP will likely to embarrass Democrats into eliminating the most glaringly unjustified deals, but not strip away any votes as a result. Meaning the bill will be “better” (for containing less pork), but will still keep the votes recruited by the eliminated pork.

Another reason health care reform is likely to pass is that Democrats can’t afford to have it defeated. The Democratic Congress has actually accomplished a significant amount in the past year (you may not agree with what they’ve done, but they’ve done a lot). That’s the argument made by Newsweek columnist Jonathan Alter. But in the public’s mind, Congress will be judged by what they do on health care reform. Their constituents, both at home and in the political arena, are demanding results. If they pass something now they will have 10 months to convince voters their fix is better than the status quo. If they fail, they will demonstrate they’re a do-nothing Congress. In these circumstances, something is better than nothing.

Painting a scenario in which health care reform goes down in flames is easy. And I’m not saying health care reform is inevitable. But this Congress and this President have gotten closer to passing health care reform than any lawmakers since the push for comprehensive reform began in the 1940s. President Obama and Democrats in Congress have bet their political credibility on producing a bill. They’re close to the finish line. Odds are, they cross it.

Of course, signing health care reform legislation into law is only the beginning. But that’s a topic for a future post.