http://thehill.com/leading-the-news/left-flexes-muscles-on-healthcare-reform-2009-08-20.html

The Hill

Left flexes muscles on healthcare reform

By Mike Soraghan
Posted: 08/20/09 09:23 AM [ET]

The fury from the left about President Barack Obama’s shift on a public option has raised the prospect of House liberals joining together to defeat a healthcare bill that doesn't meet their standards.

Heading into the August recess, having just quelled a rebellion by centrist Blue Dog Democrats, House Speaker Nancy Pelosi was clearly banking that liberals wouldn’t dare take down a healthcare bill.

“Are progressives going to vote against universal, quality affordable healthcare for all Americans? No way,” Pelosi (D-Calif.) told reporters.

But when Health and Human Services Secretary Kathleen Sebelius said Sunday that a public option is not “essential” and Obama called it a "sliver" of the effort, the backlash surprised skeptics who'd long figured they wouldn't dare to defeat healthcare and embarrass their president.

“Before, I would have laughed at you,” said a Democratic lobbyist with ties to House leadership. “But they seem to be pretty far out there. This may be the issue where they draw a line in the sand.”

The liberals' vehemence seems to have assured that there will be a public option in whatever the House votes on next month. The question is whether it will meet liberals’ demands that it be “robust,” and whether they would defeat the bill if it came back from the Senate without a public option.

On paper, liberals have the votes. The Congressional Progressive Caucus gathered the signatures of 60 members threatening to vote against a public plan they considered watered down in negotiations with centrist Blue Dog Democrats. If Republicans unite against the bill, 60 votes is more than enough to kill the bill.

“The real question is whether leadership would risk healthcare reform by not including a public option,” said Rep. Donna Edwards (D-Md.). “That letter was very clear.”

Also, former Democratic Party Chairman Howard Dean has predicted Democrats who don't back the public option could face primary opposition. And labor leaders have told the Huffington Post that they might pull support from Democrats who don't support it.

The public option has been the keystone of healthcare reform for House liberals for months. The Progressive Caucus formally demanded its inclusion in the bill in an April 2 letter to Pelosi.

It would be a government-run insurance plan that would compete with private insurers. Democrats say it's needed to drive down costs and broaden coverage. Liberals say they want a “robust” public option, which generally means it should resemble Medicare.

But it didn't draw much attention until the negotiations with Blue Dogs in the Energy and Commerce Committee detached its workings from Medicare.

That's when House liberals protested, and started gathering signatures.

That Blue Dog provision survived in the Energy and Commerce Committee, but the bill has to be melded together with bills from two other committees, and Pelosi has not committed to including the Blue Dog language word-for-word.

How much the Blue Dog language gets changed will be a key measure of how credible leadership finds the liberal threat.

Removing the public plan entirely, presumably, would inspire even more anger.

The Obama and Sebelius comments during the weekend reignited liberal fears. In a joint letter, the Progressive Caucus and the Congressional Black Caucus scolded Sebelius for her comments. And they attached the 60-signature letter.

Members say the letter underestimates the strength of liberals, that the more than 60 members would oppose a health bill with no public option. Rep. Anthony Wiener (D-N.Y.) has said deleting a public option from the House bill would cost 100 Democratic votes.

“I take my colleagues' word when they say they have the votes. And so does the Speaker,” Wiener said, noting that Pelosi quickly responded to the administration's shifting with a strong statement of support for the public option.

But the 60 signatures might be soft. The signers include lawmakers who have said they can accept health cooperatives and others who say they wouldn't vote against the House bill in the end.

The liberal record is mixed. House liberals have a history of getting rolled, such as the 2007 vote on withdrawal from Iraq. Leaders of the Progressive Caucus organized votes against the bill, saying it didn't go far enough in ending the war. But after a personal appeal from Pelosi, they stopped whipping the bill and released members from their commitments. That allowed the bill to pass.

But aides to liberal lawmakers argue that this issue is different. Liberals see a once-in-a-generation opportunity to overhaul healthcare that won't come around again for a long time. Healthcare is atop the agenda and Democrats have as much power as they're likely to have for years. The Democrats are expected to lose congressional seats next year, so their majority, and their ability to force change, will be diminished.

Liberals also argue that they have already given up a great deal by not insisting on a fully government-run "single-payer system" that most of them prefer.

"We've compromised a great deal," Edwards said.

Pelosi has committed to a floor vote on such a single-payer option, which some lawmakers expect to placate some liberal opposition.

But the 60 signatures on the letter specifically apply to the House bill. The Senate is expected to draft a significantly more conservative bill, and many have long seen the bipartisan efforts of the Senate Finance Committee as the most likely source of a bill that can pass into law.

But even if Democrats decide to “go it alone” and write a bill without Republican support in the Senate, Sen. Kent Conrad (D-N.D.) has said there aren’t enough votes to pass a public option in the Senate. He called the push for a public option a "wasted effort."

So a bill could come back from the conference committee without a public option. And a conference bill would be Obama's bill. Stopping it would no longer be an effort to shape the legislation. It would kill the top item on the president's agenda.

“If the president comes into your caucus and says we need you to vote for this, are you going to flip him the bird?” the lobbyist said.

Edwards, who signed the letter, declined to speculate on whether she would vote against a conference bill without a strong public option.

“That's a long way down the line,” Edwards said. “I am talking about the House vote.”