Dan Balz's Take
How Passing Health-Care Reform Could Change the Political Landscape
By Dan Balz
With the Senate Finance Committee vote on Tuesday, the default position for health care has flipped. From the will-it-or-won't-it-pass drama of late summer, there is now a growing presumption among Democrats and a number of leading Republicans that Congress will approve some kind of bill by the end of the year.
The path to final passage is not simple. The fragile and disparate coalition of Democratic liberals and moderates (and perhaps a Republican or two) needed to pass the legislation will be stretched to the breaking point. There will be ample opportunities for the coalition to crack apart. Nothing is yet guaranteed, given the wide gulf that still exists over some key provisions in the bill.
But failure to pass a bill now would be more of a surprise than passage. All year, White House officials have argued that failure on health care is not an option, given the debacle that followed the collapse of health care legislation in 1994. Democrats have gotten that message and are now grinding forward toward a conclusion. White House officials believe President Obama is likely to get the signing ceremony he has long hoped for.
What then are the potential political implications for the president, his party and minority Republicans if the year ends with the president hosting a big signing ceremony to herald a new era for the American health care system? A big win for the Democrats? Despair among Republicans? Not surprisingly, Democrats and Republicans have sharply different expectations for what may happen.
Democrats assume substantial political benefits, both for getting the job done and for changes that they believe the public will see as improvements in the kind of health care coverage they have. They believe the passage of a health care bill will stand with other landmark achievements that have come under Democratic presidents, such as Social Security and Medicare.
Chris Kofinis, a Democratic strategist, predicts that, at a minimum, there will be a huge, short-term benefit for the president and his party. "Big social problems create big political and policy challenges, but also huge political payoffs," he said.
White House Chief of Staff Rahm Emanuel, who was in the Clinton White House when health care failed in 1994, long has argued that there is another potential benefit, which is that Democrats can prove that they are capable of governing and making Washington work.
Given control of the White House and their big majorities in the House and Senate, Democrats should be able to enact their agenda, but the public has come to expect gridlock rather than progress and this has contributed to anger at Washington. "I think that there will be a general sense of satisfaction that we got something done," White House senior adviser David Axelrod said.
Democrats also believe that Republicans' near-unanimous opposition to the bill will provide a double benefit. Not only will Democrats be seen as the responsible, governing party, they argue, but the GOP's image as a party on the sidelines, unwilling or incapable of contributing to a solution to one of the country's most long-standing problems, will be reinforced.
The president, after months of being second-guessed about his handling of the debate and questions about what he has accomplished, may see a boost in his own personal standing as well. White House officials have told Democrats for months that the more popular Obama is, the more their 2010 prospects will be enhanced -- and that a health care bill will be a major positive step toward that future.
All that assumes not only that a bill passes, but also that in its implementation, voters see changes that they like. Democrats believe that in the short term, that is likely to be true, because some of the first changes implemented are insurance reforms widely popular with the public. Provisions that may be more problematic in their impact do not take effect as quickly.
Republicans see the environment far differently. "The sugar high from a signing ceremony just might be as good as it gets for President Obama and Democrats," said Kevin Madden, a Republican strategist. "It could be all downhill from there."
Former House Speaker Newt Gingrich believes Obama and the Democrats are heading for major problems if they add a health care bill, with all its complexities, on top of the cost of bailing out the economy. The Democrats have ignored warning signs from the public to go slower. Now, Gingrich argues, the health care bill could further harm the economy and strain health system to the breaking point.
"I think the odds are they'll pass something and I think it will be to the left of [the Finance Committee bill]," Gingrich said. "I think it's beyond trouble."
Republicans see voters potentially recoiling against legislation that would add another $800 billion or more to the federal budget. They discount Congressional Budget Office estimates that the Finance Committee bill won't blow a bigger hole in the deficit, and say the health care legislation will be cost the government hundreds of billions more in the years not covered by the 10-year window. They also argue that the final product will be more expensive, with fewer cost controls, than the Finance Committee bill.
"Even if the CBO blesses this bill, Obama and the Democrat-controlled Congress will own the explosion of spending and the federal deficit at the ballot box in 2010 and 2012," Madden argued.
Other Republicans sees the potential for the Democratic coalition to fracture further as the debate nears a conclusion. Liberal and labor union opposition to the Finance Committee bill could collide with the House Blue Dogs and Senate moderates. If, in the middle of these final negotiations, Democrats lose the Virginia and New Jersey governors' races next month, the party could emerge more deeply divided.
Republicans also believe that, in the final months of the legislative debate, there will be growing criticism of the bill, particularly from some of the industry stakeholders who have generally held their fire until now. That could divide the country further and make Americans more skeptical about the implications of a new health care system.
"I'm not sure you can ever resolve that debate or discussion," Axelrod said hours after the Finance Committee vote. "At this point, I think you have to enact it and implement it well. I think people are prepared for us to enact it. I think there are elements of it that will come on line quickly on which those who supported it will be able to campaign on next fall."
Neither side can be too confident in their assumptions. The Bush White House and Republicans anticipated major benefits from passage of a prescription drug benefit for senior citizens. Initial reaction was negative. Even when opinion turned more positive, other issues proved more powerful and politically costly in Bush's final years. The same could happen next year, especially if the unemployment is high.
The fact that opponents and proponents now think passage is more likely than impasse marks another important step in the battle over health care. But it is clear that the arguments will not cease with the possible enactment of a bill. The debate will shift to a new arena, but it will not subside for some time.
Posted at 4:44 PM ET on Oct 14, 2009
Dan Balz's Take
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