After decades spent dreaming about health-care reform, Democrats finally managed to pass a bill through a chamber of Congress last night.

While all the focus has been on the Senate lately, the House leadership was facing just as tough a task. With a group of about two dozen Blue Dogs sure to oppose the measure however watered down they managed to make it and with liberals better organized than usual to prevent the bill’s dilution, it wasn’t always obvious how Nancy Pelosi could gather 218 votes - especially when you consider that allĀ all vulnerable Democrats up for re-election in 2010 (rather than just a third on the Senate side).

At the end of the night, however, the House adopted the bill 220 votes to 215, which means Pelosi had just two votes to spare. 39 Democrats opposed it, while Rep. Anh Cao was the lone Republican to vote yes. (The roll call is here.)

Too much should not be read into just how narrow the margin was, by which I mean that it is highly unlikely the GOP was just 3 votes away from triumph: It is no coincidence that both this vote and the one on the cap-and-trade bill (which passed with 219 votes back in June) won with bare majorities. Democratic leaders will allow some of their vulnerable members to break party lines if it can help them; that doesn’t mean they had more than a handful of reserve votes, but had 3 more Democrats voted ‘no,’ Pelosi and Clyburn probably had a handful of lawmakers willing to change their vote to “yes.”

Stupak amendment passes, with 64 Democratic ‘yea’s

On the other hand, the Democratic leadership does look to have been more pressed for votes than it might have been expecting: A group of lawmakers led by Rep. Bart Stupak warned they would oppose the bill if anti-abortion provisions were not toughened - and, as is always the case, such threats are more credible coming from the right than from the left. Nancy Pelosi relented, allowing a vote on an amendment Stupak drafted in collaboration with the U.S. Conference of Catholic Bishops in the hope of winning the support of pro-life Democrats on the bill’s passage. (Update: Politico has a must-read story that contains details about just how involved the Church was.)

The amendment was adopted by a large majority composed of 176 Republicans and 64 Democrats (the roll call is here), handing liberals a highly consequential defeat in what would otherwise been a historic night.

Indeed, last night’s vote is arguably the pro-life movement’s biggest congressional victory since the Hyde Amendment was first adopted in 1976. The measure prohibits insurance companies from offering plans that cover abortion procedures and that are eligible to be bought by people with subsidies. As such, a woman on the individual and small business exchange could not buy insurance that covers abortion unless she bought separate insurance intended to specifically cover that procedure - an unviable proposition for low-income women, and probably for most people. (More about the amendment from Ezra Klein and John Cohn.)

Given that there are a fair number of pro-choice Republicans in the House, it was somewhat of a surprise that all supported the Stupak amendment: Reps. Mary Bono Mack, Mike Castle, Mark Kirk, Judy Biggert, Lynn Jenkins, Rodney Frelinghuysen, Charlie Dent and Shelley Moore Capito all received financial support from Republican Majority for Choice in 2008. The only GOPer who did not support the measure was conservative Rep. John Shadegg; he argued pro-life Democrats would oppose the entire bill if the Stupak amendment failed, so he wanted Republicans to defeat the latter to sink the former.

As for the 64 Democrats who voted “yea”, the list is mostly comprised of conservative Democrats whose alliance with Republicans is expected no matter the subject at hand (Bright, McIntyre, Matheson, Melancon, Griffith, Taylor, Hill, Chandler, Salazar, Peterson and many others); that said, there are a few who represent heavily blue districts and who are considered liberal on issues other than abortion (Marcy Kaptur, Richard Neal). Also noteworthy is Rep. Bob Etheridge’s “yes” vote: If he decides to jump for Senate, that could play a significant role in his primary against Elaine Marshall.

40 defections on the bill’s final vote: 39 Democrats, 1 Republican

The vote on the Stupak amendment was followed by a vote on an amendment proposed by the GOP that would have scrapped the entire bill to replace it with the Republicans’ reform plan. While the measure went down 187-247, 13 Democrats - the who’s who of conservative House Democrats - did support it: Boren, Bright, Cardoza, Childers, Costa, Cuellar, Ellsworth, Bart Gordon, Griffith, Matheson, Minnick, Scott Murphy and Pomeroy.

11 of these 13 lawmakers are in the Blue Dog Coalition - all but Cardoza and Murphy. Yes, that’s the Scott Murphy who recently won the special election in NY-20, a district Barack Obama won in 2008. Cardoza, Costa and Cuellar represent districts that gave Obama double-digit victories.

Somewhat puzzlingly, Cardoza, Costa and Cuellar voted in favor of the bill itself (talk about trying to have it both ways, especially given their indecision leading up to the vote). The other 10 - including Murphy - opposed it. They were joined by 29 other Democrats, bringing the total number of defection on that side of the aisle to 39. The full list is:

Adler, Altmire, Baird, Barrow, Boccieri, Boren, Boucher, Boyd, Bright, Chandler, Childers, Artur Davis, Lincoln Davis, Edwards, Gordon, Griffith, Herseth Sandlin, Holden, Kissell, Kosmas, Kucinich, Kratovil, Markey, Marshall, Massa, Matheson, McIntyre, McMahon, Melancon, Minnick, Murphy, Nye, Peterson, Ross, Shuler, Skelton, Tanner, Taylor, Teague

24 of these Democrats are Blue Dogs - which means that 46% of that group opposed the bill. 14 of them are freshmen, which means 37% of all Democrats who’ve been sworn in this year voted ‘no.’ 31 represent districts won by John McCain last year - including 19 in which the Arizona Senator prevailed by double-digits.

That means that 8 are from districts won by Obama: Adler, Baird, Barrow, Davis, Kissell, Kucinich, Murphy and Nye. In particular, Obama won victories superior to 5% in the districts of 4 of these 8 Democrats: He received 74% in AL-07 (Artur Davis is running for Governor in Alabama, which explains his vote), prevailed by 18% in OH-10 (Kucinich opposed the bill from the left, one of two Democrats to do so), prevailed by 11% in GA-12 (Barrow) and 8% in WA-03 (Baird); both GA-12 and WA-03 voted for George W. Bush in 2004.

All of this is to say that the group of lawmakers bucking their party is the typical cross-section of conservative Democrats and vulnerable incumbents.

I for one find it more likely that vulnerable Democrats lose their re-election if their party fails to pass health care reform than if the legislation is adopted. That might not apply to lawmakers like Bright and Minnick who represent very heavily Republican districts, but it certainly does to those like Kissell, Nye, Barrow and Kosmas who are sitting on top of swing districts: The narrative of an overreaching Democrats would drive away independents, the bill’s failure would make it unpopular and the party’s inability to reach its goal would depress base turnout.

Since Republicans are sure to make the most of any Democratic “yes” vote, vulnerable incumbents might have been best off if the bill passed while they opposed it. For that to work, some vulnerable incumbents have to be willing to vote “yes,” however, otherwise the bill would go down. And indeed, a significant number of vulnerable lawmakers did support it.

Here is a partial list of Democrats whose “yes” votes I believe is newsworthy, either because they’re facing a competitive race in 2010 (statewide run or re-election) or because they are generally considered moderate-to-conservative:

Arcuri, Bishop, Dahlkemper, Donnelly, Driehaus, Ellsworth, Etheridge, Hill, Hodes, Kagen, Kanjorski, Kilroy, Dennis Moore, Bill Owens, Perriello, Peters, Pomeroy, Salazar, Schauer, Shea-Porter, Space, Stupak, Titus

Perhaps the most important name on this list is that of Perriello, who is near the top of the GOP’s target list. The freshman spent most of the summer saying he was leaning towards opposing the bill but that he was looking to get to a yes, and he ultimately did get there - just as he had during the cap-and-trade vote. Space is another Democrat representing a McCain district who’ll go into 2010 having supported both the cap-and-trade and health care bills.

Might either have voted “no” if safe Democrats like Chandler or Peterson had agreed to support the bill? That’s all the more important a question given that Peterson is a committee chairman, and as such a member of the Democratic leadership. It’s also worth highlighting that this is a rare instance in which Indiana’s 3 Blue Dogs (Donnelly, Ellsworth and Hill) all backed the leadership on a contested vote; when’s the last time that happened?

As for Bill Owens, rarely do we get this clear an instance of an election having consequences: He won by a few percentage points just a few days ago. Had Doug Hoffman been elected, Democrats would have been down to 219 votes - not 2 but 1 vote from defeat given that Anh Cao only deserted his party once he saw that Pelosi had reached 218 votes.

Indeed, we are now left with the sole Republican who deserted his party. While his vote comes as a surprise because of the party unanimity Republicans had been able to impose on important votes like that on the stimulus bill, it’s far from shocking: The New Orleans congressman is the most endangered incumbent in the 2010 cycle, since he represents a heavily Democratic district. If he wants to have a small shot at surviving next year, Cao will have to be able to point out to a few instances in which he did cross party lines - and this is one high-profile instance to which he’ll be able to point.

What’s next?

There is no need for a long analysis of what awaits the health care bill. Most of the attention was already devoted to the Senate process, which (fairly or unfairly) has been portrayed as a bigger risk for Democrats, so we’ll now go back to monitoring the 5 senators who have left the door open to supporting a GOP filibuster: Joe Lieberman (who reiterated that he’d oppose cloture this morning), Mary Landrieu, Blanche Lincoln, Ben Nelson and Evan Bayh.

9 Responses to “220-215”

  1. 1 fritz

    Hi Taniel:
    Can you explain your remark re John Shadegg voting present to protect the Stupak amendment from being defeated. I don’t think that was ever in any danger of happening.
    I think Rep Cao may eventually join the Democrats as he is more likely to survive a Democratic primary as opposed to a Republican one that will almost certainly come from the tea party crowd. He will have no chance against an almost guaranteed AA Democratic opponent in the general.
    Peterson is the House’s version of Backus; a Democrat whose main concern is how a bill will play to agribusiness lobby.

  2. 2 Maurice

    Well, I’m pretty sure this ups Arcuri and Shea-Porter’s prospects next year.

    The only Senators that are really worrisome are Lieberman and Nelson, and the latter not so much. Bayh will almost definitely give in along with (as you mentioned) the rest of his state’s delegation. Lincoln isn’t left with much of an option with the pro-option money she’s been getting plus Berry and Snyder’s yes votes. And Landrieu has a long time till election plus Cao’s vote… And Nelson is not that stupid. And Lieberman is an idiot, and he probably would be willing to kill health care; even proud of it.

    P.S. I believe the Blue Dog vote was 28 yes - 25 no.

  3. 3 Panos

    Everybody is talking about the consequences of that vote for the Democratic lawmakers next year. But what about the Republicans?

    How will Castle and Kirk run statewide in heavily blue states as moderates when they voted FOR the Stupak amendment and AGAINST the HCR bill? Giannoulias and Beau will have a field day with these votes and the pro-life movement must be especially angry with the two Republicans.

    Anyway, I think that if the bill came so far Reid and Obama must be suicidal not to use reconciliation in case some Dem senator wants to sink it.

  4. 4 Panos

    I meant of course the pro-choice movement.

    And by the way, has Adler explained why he voted no?

  5. 5 Taniel

    Fritz: I wasn’t clear in my original phrasing. Shadegg wanted the GOP to help defeat the Stupak amendment so pro-life Democrats were then moved to oppose the entire bill, potentially helping defeat it.

    Panos: We still have to see whether Biden runs… but state Democrats are already pressuring Castle on health care. As for Adler, here is his press release; nothing too specific, but some fiscally conservative positions about the high cost and insufficient crackdown on fraud and waste.

  6. 6 Guy

    Maurice - I agree that Bayh will vote for it in the senate. He used to have the cover that he represented Indiana and everyone thought “he has to be conservative because the GOP Presidential candidate wins by 20%”. Well that excuse went last year and in future if the Dems put the effort in the election in IN should at least be in single digits. He will also want to guard against any threat from the left. His reputation will ensure he is pretty safe in a GE.

  7. 7 Preston

    I think its laughable that so many Republicans across the country are so angry at Cao. I’m certainly not going to donate to his campaign or fly to New Orleans to campaign for him, but he is really all the GOP has in that district and he will still lose re-election. For the life of me I can understand why anybody that is fiscally conservative could vote for this bill, and Cao has proclaimed to be a fiscal conservative. But he will be the GOP nominee in 2010 and is the only Republican shot. This is his first really terrible vote that I can think of.

  8. 8 Guy

    Preston - this bill is more fiscally conservative than the prescription drug benefit entitlement passed by a GOP held Congress and signed by a GOP President. This bill will not add to the deficit and reduces the projected increase in healthcare costs.
    The US spends 16% of GDP on healthcare which is double the average for other rich, western countries. This means money is being spent on healthcare that could have been spent on other, perhaps better, things.

  9. 9 Preston

    The prescription drug bill was stupid and it is just plain idiotic to believe that the healthcare bill will not add to the defecit.

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