Do or Die: The Six Senators Who Will Decide the Fate of Health Care Reform

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Senate Majority Leader Harry Reid faces a number of obstacles to passing health care reform but his main task is to keep his caucus united for not one, but two, supermajority votes, just to get the reform bill an up or down on the Senate floor. Failure to get 60 votes to push past either of those two procedural chokepoints could derail the reform bill. Here are the six key holdouts Reid must wrangle to reach the magic threshold.

Sen. Ben Nelson (D-NE)

Sen. Ben Nelson (D-NE) is by most measures the most conservative Democrat in the Senate. On almost all major legislation, Nelson digs his heels in and withholds his cloture vote until the bill moves to the right, and has a few Republican supporters. Health care is a bit of a sui generis issue for Democrats, so at the end of the day he may not be so intransigent. But for the time being, he says he wants Sen. Olympia Snowe (R-ME) on board for whatever bill comes to the floor, and that means he’s opposed to the the public option Reid is proposing. He also opposes the bill’s likely funding mechanism–an excise tax on generous “cadillac” health insurance policies. Reid’s first task is to simply get the bill on to the floor for debate. He’ll need 60 votes for that, and Nelson says he won’t commit one way or another until the CBO weighs in and the bill is unveiled.

Sen. Blanche Lincoln (D-AR)

As a rule, Sen. Blanche Lincoln (D-AR) may not be as ideological as Nelson is. But she’s got a problem on her hands right now that Nelson doesn’t. She’s an unpopular senator in a conservative state and she’s up for re-election next year. Unlike Nelson (or Joe Lieberman, who we’ll get to momentarily) securing Lincoln’s procedural vote is a nuts-and-bolts political problem. How do you get her into a position where she (and the Democratic party) feels her seat isn’t particularly imperiled by votes for health care reform. Last week, she met with both Reid and President Obama. Those conversations will surely continue.

Sen. Mary Landrieu (D-LA)

Sen. Mary Landrieu (D-LA) is also from a conservative state. And, like Nelson and Lincoln, her preference is for a bill that has Snowe’s support. But there’s at least one reason to believe she may not be the hardest vote to get: She just won re-election. She has until 2014 before her votes for or against health care reform will come back to haunt or help her. In other words, it will be harder for her to make a straightforward political argument to party elders for standing in the way of a health care bill–and there may already be signs of softening. Though she says still opposes the public option without a trigger, last week, she conceded “The public option, because of the moderates, and because of what I’ve been helping to do and other moderates, has been shaped, in our view, 100 percent better than when it started out. It’s already shaped to be a public option that is supported by premiums.” And earlier in the week, she co-hosted a pro-reform event on the hill with a number of small-business owners. Still, like Nelson and Lincoln, she says she won’t decide on her first procedural vote until the bill is unveiled and the CBO has weighed in.

Sen. Joe Lieberman (I-CT)

Reporters and pundits have been obsessed with Sen. Joe Lieberman (I-CT) since he first announced his intent to support a health care filibuster if the bill includes a public option. And with good reason. Unlike Nelson, Landrieu, and Lincoln, he’s been crystal clear about his intentions. Reid says he and Lieberman haven’t reached an understanding, but that he’s not terribly worried about Lieberman in the long run. Maybe that’s right. Maybe it’s bluster. But if Lieberman is just showboating, he’s digging himself a pretty deep ditch. “If the public option plan is in there, as a matter of conscience, I will not allow this bill to come to a final vote because I believe debt can break America and send us into a recession that’s worse than the one we’re fighting our way out of today,” Lieberman said on Fox News this weekend. That argument doesn’t make sense on a substantive level–the public option is a big money saver, and the government would have to change the law (i.e. find 60 votes) to subsidize it in a way that adds to the debt. But even if his justification makes no sense, there’s no wiggle room to his threat. However, Lieberman’s constituents will be paying attention–unlike those listed above, Lieberman comes from a liberal state–and for the time being, Lieberman says he’s likely to vote for the first procedural motion, but against the second one. That means Reid (and perhaps the White House) have a few weeks before they need to start twisting his arm.

Sen. Evan Bayh (D-IN)

Sen. Evan Bayh (D-IN) raised liberal hackles a couple weeks ago when he said he planned to treat procedural and substantive votes on health care equally–in other words, he would filibuster any bill he didn’t agree with on the merits. But he quickly, though only partially, relented, when he said he would at the very least vote to move the bill to the floor for debate regardless of whether or not he likes the legislation itself. Bayh’s main concern isn’t the public option–it’s the fiscal soundness of the plan. But he also says he objects to some of the fees the bill would likely impose on industry–particularly medical device manufacturers–and it’s conceivable that he could use a filibuster threat to change, or attempt to change, some of those provisions down the line.

Sen. Kent Conrad (D-ND)

It wasn’t all that long ago that Sen. Kent Conrad (D-ND) was a public option scold. These days, he’s not nearly so vocal. He made a concerted (and ultimately successful) push to prevent the public option from being tied to Medicare, and, since then, he’s been careful not to speak out too loudly against the weaker public option Reid put in the bill. But, like Bayh, he will become a quick ‘no’ if the bill Reid unveils isn’t deficit neutral, and a cost-saver in the long term. The Senate Finance Committee bill succeeded on that score. If the changes Reid made in the merger process make the bill a budget buster, he’d likely lose Conrad’s support, and many others’ as well. That’s one reason to think Reid took care to make sure this doesn’t happen.

It’s worth remembering that there are liberal members of the Senate–most notably Roland Burris (D-IL) and Bernie Sanders (I-VT)–who could defect on procedural votes if the bill moves too far to the right. But for the time being, Reid’s goal is to bring conservative Dems aboard. If by doing so, he puts the bill in jeopardy of being killed by liberals, we’ll put together a similar list of progressive swing votes.

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