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The House health care debate: What to watch for

By Paul Kane
The House has officially begun debate on President Obama's massive health-care proposal, with a final vote likely to come some time after 8 p.m. Several key moments have already occured, while a few more are in the offing, providing a glimpse of what the outcome will look like once all the votes are tallied. With not a single Republican expected to support the legislation, House Speaker Nancy Pelosi (D-Calif.) needs at least 218 of the 258 Democrats -- about 85 percent of the caucus -- to vote yes to reach victory.

Here's an insider's guide to the day's big moments:

* Opening Gavel: Democratic leaders had hoped the day's session to begin around 9 a.m. Saturday, about an hour earlier than most legislative sessions start, but they first took up a few non-controversial, unrelated pieces of legislation. According The Post's Sketch maven Dana Milbank, the formal health-care debate kicked off at 10:42 a.m. That was the preliminary debate on the bill, overseen by Reps. Louise Slaughter (D-N.Y.) and Pete Sessions (R-Texas), the chairman and a senior Republican on the Rules Committee.

* Rules of Debate: The first hour or so of debate on the nearly 2,000-page legislation focused on what is known as "the rule." Slaughter's committee establishes the rules governing the debate for every key piece of legislation -- how long each side gets, how many amendments can be offered, which amendments can be offered. In addition, the Rules Committee makes last-minute changes to the overall bill, and this time around Slaughter inserted language designed to be a compromise on abortion. A bloc of two dozen Democrats, many of them anti-abortion Catholics, held out support because they believed the original draft would open the door to federal funding of abortions. The "rule" vote is routinely party line, but 15 Democrats voted against the rule because they either did not support the abortion compromise or opposed the overall legislation. This vote occured shortly after 1 p.m., winning approval on a 242-192 vote. All Republicans voted no, and Pelosi -- as is often the custom with the House speaker on non-controversial matters -- did not vote. Do the math: This means all 435 members of the House are here.

* POTUS Visit: President Obama paid a lunchtime visit to Capitol Hill to attend a meeting of the House Democratic Caucus, effectively serving as the closer for the legislation. He tried to get the final few undecided Democrats to support his hallmark legislative initiative. After a flurry of visits to the Capitol in January and February to rally support for his economic stimulus package, Obama has been an infrequent visitor to his former place of work. He's hosted plenty of lawmakers in the Oval Office for lobbying sessions, but has not come before an entire caucus of Democrats in many months, showing the significance of this vote to his administration.

* Beware of the blue screen: Pelosi has exuded confidence that she will have the requisite 218-plus votes for passage, but sometimes land mines appear out of nowhere that put the bill in grave danger. This sometimes leads to emergency meetings of the Democratic caucus, halting proceedings in the House. On C-Span, viewers would see a note saying the House has been "recessed". Lawmakers and aides call this a "blue screen" moment because their televisions are set to an internal station that shows a picture of the Capitol dome with a nice sunny blue sky in the backdrop. These are anything but pleasant moments, because usually, somewhere inside the Capitol, a tense meeting is underway that will decide the fate of the legislation.

* The Definite No's: In advance of the vote, almost 20 Democrats publicly declared their intention to vote against the legislation. A large chunk of them are Southern Democrats from conservative-leaning districts, such as Reps. John Tanner (Tenn.) and Larry Kissell (N.C.). Others are freshmen facing the most difficult vote of their fledgling careers, such as Reps. John Adler (D-N.J.) and Frank Kratovil (D-Md.). Others who announced their opposition on Saturday were freshman Reps. Glenn Nye (D-Va.) and Eric Massa (D-N.Y.) and Rep. Chet Edwards (D-Texas).

* The Bellwethers: Certain lawmakers will signify whether the legislation will pass, and by what margin. One such key player is Rep. Ann Kirkpatrick (D-Ariz.), a freshman who took the seat of a retiring, scandal-plagued GOP incumbent and now faces a tougher test in her first reelection bid next fall. Senior Democratic aides confirmed, after Obama's meeting, that Kirkpatrick is a now yes vote.

Another pair of key votes are Reps. Zack Space (D-Ohio) and Baron Hill (D-Ind.), both members of the Blue Dog Coalition, a collection of more than 50 Democrats hailing from rural districts. Pelosi does not need every Blue Dog vote for the legislation, but she needs some. Space and Hill supported an earlier compromise version at the committee level in July, but the legislation has been altered since then.

* Stalling tactics: Just because the rules of debate say that there will be five hours of debate once the rule has been approved, don't presume that there will be exactly five hours. Republicans may try some parliamentary moves as a show of protest, and there's also the House version of a filibuster.

The top floor leaders -- Pelosi, House Majority Leader Steny Hoyer (D-Md.) and Minority Leader John Boehner (R-Ohio) -- are given special privileges, so that they can speak as long as they want without cutting into the overall debate time. In June, when the House was about to pass a climate change bill with little GOP support, Boehner read long passages from the text of the bill. He went on for more than an hour. GOP aides do not expect top leaders to engage in such tactics, but some privileges extend to all lawmakers, so some rank-and-file Republicans could pull some antics such as forcing a vote on a motion to adjourn the chamber as a delaying tactic.

* The GOP alternative: After months of hectoring from Democrats, Republican leaders finally unveiled their own alternative health-care legislation this past week. It has no chance of winning approval. A key thing to look for is how many Republicans vote against their own legislation, such as moderates who face difficult reelection battles every two years.

* Recommitting: Republicans also have one extra trick up their sleeves: They are allowed to offer a "motion to recommit" the legislation, a vote that would technically defer a final vote and instead send it back to committee. In recent years, the GOP has worded its MTRs, as they are known by House insiders, in such a way as to ensnarl vulnerable Democrats on tough issues such as immigration. Republicans would not say what their MTR would look like, but Democrats were girding themselves for what could be a tough vote. When the debate concludes, there will be a trio of votes, starting with the GOP alternative and then the MTR, before moving on to the final vote.

* The Prolonged Vote on Final Passage: Once the final vote begins, it will last 15 minutes. However, many votes drag out a bit longer, to allow some members extra time to get to the floor from their offices or to allow the switching of votes. The latter reason is a crucial one Saturday: If leadership finds itself a few votes shy of the magic 218, expect them to leave the vote open as they talk to Democrats who are on the fence. An infamous 2003 vote on expanding prescription drug coverage through Medicare lasted more than three hours.

* The airport caucus: Like almost every big vote in the House, this one falls at the end of a long week when the House is set to go on recess and members are ready to return to their districts. Sometimes fence-sitters quickly cast their no votes and slip out a side door to race off to a nearby airport, rather than face their leaders and the last-ditch effort to get them to switch to yeses. If the Democrats have 218 locked down, these folks won't matter, although they may face a lecture later this month.

* Cheers or groans: C-Span's feed for television is a second or two behind the vote tally shown inside the House chamber, so lawmakers will know when they top 218 votes before the TV audience at home. If the C-Span vote tally shows something like 210 yes votes but a loud burst of cheering erupts, that means Democrats have seen their electric vote board surpass the 218 threshold. Prolonged silence while the vote tally hangs below 218 is bad news for Democrats.

By Paul Kane  |  November 7, 2009; 6:00 AM ET
Categories:  Health Reform  
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PELOSI: Buy a $15,000 Policy or Go to Jail
JCT Confirms Failure to Comply with Democrats’ Mandate Can Lead to 5 Years in Jail

Since it's mostly democrats that can't afford health care, isn't Pelosi's mandate going to send her own kind to jail?

Posted by: charlietuna666 | November 7, 2009 6:58 AM | Report abuse

Time to wake up and smell the roses! Today's private insurer-controlled health care system is bankrupting our government and the American people. Reality sucks but we all are paying the excessive costs, whether it be in dollars or in little or no health care. The system is broken......

Medicare for all makes the most sense but the Repugs/Conservatives had rather keep those industry CEO and upper management profits flowing. Reality, again. Today's Dem plan is a little half-as_ed but it is the best available to start cleaning up the mess. The Repug plan is just more Corporate Welfare.

An Independent

Posted by: aeaustin | November 7, 2009 7:56 AM | Report abuse

The Rep. haven't a chance in h**l of having their Health proposal passed, or should I say it will be just passed over.

If some of these D's are holding out in the South just to try to protect their political positions in their state. Shows to go you, what is more important to these stupid individuals their selfishness, ignorance or the good welfare of the countrt.

If this vote hangs on the abortion issue, there will be plenty of wire hangers used to kill off persons who want abortions -- and set the nation back a good 50 years!!!!!!

Posted by: LOONYBIN2000 | November 7, 2009 8:26 AM | Report abuse

Political risk is an understatement. If my representative votes for that San Fransisco liberal garbage pile, I swear I will spend the next year doing everything I can as a citizen to help put him on the unemployment line next year. You can damn well bet on it.

Posted by: donchew1 | November 7, 2009 8:49 AM | Report abuse

here must be terrible hidden agenda bills in this Health? Bill. I'm afraid it's time something to be done. We cannot wait for 3 more years. By then we shall all be bound in chains or in jail or dead.

Posted by: jackolantyrn356 | November 7, 2009 9:32 AM | Report abuse

Although WoPo was quick to report President Obama’s Thursday announcement of the American Medical Association (AMA) endorsement of the House health care reform bill on in his attempt to beat back criticism that the bill would gut Medicare, I notice the WoPo conveniently has neglected to mention that the AMA endorsement has triggered a revolt among many members who want the endorsement withdrawn. Several members are outraged that the trustees made the endorsement without the formal approval of the organization's House of Delegates so on Monday, delegates will vote on a resolution to withdraw the AMA’s endorsement of the bill.

Posted by: A-COL | November 7, 2009 9:57 AM | Report abuse

Insert partisaned vitriolic statement here.

Posted by: egc52556 | November 7, 2009 10:00 AM | Report abuse


Far be it for me to correct an expert like you, but the Motion to Recommit with Instructions rule was gutted at the beginning of this session.

An Aye vote returns it to the floor "forthwith."

Posted by: jfxgillis | November 7, 2009 10:21 AM | Report abuse

I'm sick and tired of this crap bout people not being abe to afford health insurance...true there is some thart can't but there is a whole lot more who can and say they can't.....they can't afford insurance but they have a 400 month car payment and credit cards maxed out....they can afford it...but they rather live beyond their means,,,,,,

Posted by: lucygirl1 | November 7, 2009 10:45 AM | Report abuse

I'm 58 years old and have never been more angry with the socialists who run our country than now. They are actually threatening me with 5 years in prison for planning to refuse to buy insurance from Obama. I'm sickened by this country. How can it be that we gave dictatorial power to the Democrats to destroy our way of life and throw us in prison or hit us with huge fines if we don't toil and buy an insurance product from them over which they have full control? This is EXACTLY what people in communist nations lived under. I am extremely bitter.

I'll do almost anything, especially something "illegal" to fight these thugs.

Posted by: BillCarson2 | November 7, 2009 2:25 PM | Report abuse

For Mrs. Pelosi to threaten jail for an American citizen that does not buy a $15,000 Health Insurance policy every year is Un-American. If this is true, this would be harassment and forcing undue burden on the American taxpayer. On what and who's authority does the Speaker of the House Speak? This is a threat against an American citizen, which is UnConstitutional on its' face and could rise to the level of impeachment. If representatives are "Insane", they can be impeached. Also, if a representative of Congress is not upholding the United States Constitutional Oath; that they promised upon taking their Office, they should be impeached. "Abuse of Power" comes to mind.

Posted by: Logic3 | November 7, 2009 3:31 PM | Report abuse

When it's time to vote for this abominable health plan, legislators should remember that they are being watched very carefully by the voters and we will not forget your decision next year at election time. Most of you who vote for this bill will be leaving Washington for good at that time and you probably won't be flying home in one of Nancy's jets.

As an Independent, I am also fed up with the Republicans who came out this week and announced they have a health plan. Seems to me that announcement came a little bit late in the game. Was there any reason you didn't buy some air time and explain to us just what the new plan is?

Let's clean house next November....

Posted by: pepperhead | November 7, 2009 5:46 PM | Report abuse

The House will be cleaned in 2010. Goodbye Dems. Hello to the people who run against those who voted for this Bill.

This will not be good for Obama and his minions in the long run. We now know for certain who is representing their constituents and who is representing Obama and Pelosi.

In fact, it may be that people will use this year to find a whole lot of evidence to get Obama out of office. He will feel safe and secure with his 219 votes but he really has no clue about how the American people feel about his policies since he "doesn't see" tea parties or Fox News or anyone who doesn't agree with him.

Guess no one ever told Obama that saying about when you are digging your self into a hole, you should stop digging. He just doesn't know when to quit digging.

Posted by: letscheck | November 7, 2009 11:36 PM | Report abuse

Debate..what to watch for?

hmm I just hope everything will be discussed and decided properly for the good of all nation...

There's this site I found...
I've read quite a few sensible articles about Health care plan and other important issues..

I read it everyday ...

Posted by: fozzy13 | November 8, 2009 1:14 PM | Report abuse

Will you please listen to the people who vote for you?

We don't want a goverment plan
We do want insurance to be sold across state lines
We do want the preexisting rules removed
We do want employers to offer insurance either fully insured or self funded with out taxing them on plans. We are tired of secret meetings that promise power and money to people WE voted for. Shame on you if you are taking money for a vote!

Posted by: Fall2009 | November 8, 2009 5:09 PM | Report abuse

We certainly need health care reform, but not in the way it is being directed. The first action to take must be to forbid advertising of prescription drugs. All the money used for advertising, drug dealers visits to doctors offices and buying influence in Washington not only drives our health care costs up but inhibits progress in stemming our worsening national health problems by not allowing information, other than that directed by the pharmaceutical companies, to reach the general public. True health care should be directed at improving health without consideration for profits.

Posted by: mdemartini | November 8, 2009 5:28 PM | Report abuse

The current US health plan has many loopholes.

1. It does not qualify Americans for any additional health benefits who beside getting some social security also have some hard and small amount of money lying in their IRA account for a rainy day.For instance I and my wife get some social secuity which is not enough for our living needs unless we use some additional money from our IRA account every year to offset the shortage.Using our IRA every year to offset our medical needs is like gradually cutting our own resting branch to a dead end. Question is what then?

(2) American Insurance does not provide any protection or coverage to Americans stranded abroad due to medical emergencies beyond their control. When approached for help they cite Federal Law or rules restricting help to such americans. For instance I came to India to visit my family members after 20 years with my
wife who is a diabetic & a heart patient in 2007 and could not return since my wife got a stroke and is completely bedridden since. I am badly caught up in a situation situation not in my control. My only insurance 'HUMANA' stopped my coverage saying I am out of their service area and that law does not provide coverage in such cases. This is when their Insurance package did provide coverage to Americans upto $25K with emergency hospitalization abroad.

I have appealed with copies to the President, Sec of State and to some of my Senators in Virginia but with no response so far.

To be honest our Insurance package is too far off from realities. What US needs is free medical insurance to atleast americans who are above the age of 70 till they die. This is a must.

Posted by: bhatiapran881 | November 9, 2009 9:04 AM | Report abuse

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