In November, House Speaker Nancy Pelosi passed a health care bill by almost the slimmest of margins. The final vote was 220-215. One Republican--Rep. Joseph Cao (R-LA)--voted with 219 Democrats to pass the bill.
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Pelosi probably could have forced a wider victory, but freed up vulnerable members to vote against the bill for political reasons. Next year, though, her caucus will be faced with a fairly different, less progressive bill--something modeled on the Senate's health care package--and she'll likely have to draw on a marginally different coalition of members.
On the left, Pelosi could lose some progressives, miffed about the demise of the public option, and unhappy with the abortion language in both bills. On that score, she could lose a number of resolutely pro-choice Democrats. Cautioning that the abortion language in the conference report hasn't been finalized yet, and that nobody's committed to vote one way or another, one keyed in aide said members like Reps. Diana DeGette (D-CO), Jane Harman (D-CA), Rosa DeLauro (D-CT), Louise Slaughter (D-NY), and Jan Schakowsky (D-IL) have grave concerns about both the House and Senate bills' abortion provisions.
Of course, with 218 members needed to pass a bill, and 219 Democrats voting 'aye' the first time around, Pelosi faces a nearly zero-sum game. If she encounters defections from her progressive wing, she'll have to make up those votes among conservative-voting freshmen, sophomore, and Blue Dog members, who opposed the House bill the first time around.