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Monday, Nov. 02, 2009

Health care bill gaining 'inevitability'

WASHINGTON — After months of plodding work by five congressional committees and weeks of back-room bargaining by Democratic leaders, President Barack Obama's arm's-length strategy on health care appears to be paying dividends, with the House and the Senate poised to take up legislation to insure nearly all Americans.

Debate in the House is expected to begin this week, and the Senate will soon take up its version. Democratic leaders and senior White House officials are sounding increasingly confident that Obama will sign legislation overhauling the nation's health-care system — a goal that has eluded American presidents for decades.

The Senate Finance Committee chairman, Max Baucus of Montana, described "a sense of inevitability, the sense that, yes, we're going to pass health reform." In interviews, senior advisers to the president said the progress on Capitol Hill vindicated Obama's strategy of leaving the details up to lawmakers, though they are wary of sounding overconfident.

"You don't see any shimmying in the end zone," said Rahm Emanuel, the White House chief of staff. "No spiking the ball on the 20-yard line here."

The bills have advanced further than many lawmakers expected. Five separate measures are now pared down to two. But the legislative progress has come at a price. In the absence of specific guidance from the White House, it has moved ahead in fits and starts. From here on, the challenges will only grow more difficult.

In the House, where leaders have vowed to pass a bill by Nov. 11, a fight over abortion coverage could still imperil the legislation, and Obama could lose some votes from liberals upset that the bill includes a weakened "public option," a government insurance plan to compete with the private sector. Obama, trying to keep liberals in line, met with them Thursday night in the White House Roosevelt Room.

"He is making the case to them that this isn't the exact bill you'd write; however, let's take a step back and look at what we're about to do here, and what a historic moment this will be," said a senior administration official, speaking on condition of anonymity to discuss a private meeting.

In the Senate, where Democrats will need support from every member of their caucus to reach a critical 60-vote threshold to avoid a potential filibuster, Obama's hands-off strategy carries particular risks. Without clear direction from the president on the public option, the Democratic leader, Sen. Harry Reid of Nevada, moved ahead last week on his own, unveiling a bill that includes a government-run plan, but allows states to opt out.

Within hours, the proposal was being questioned by centrist Democrats whose concerns Obama must now address. As Sen. Benjamin L. Cardin, D-Md., said, "When you are seeking 60 votes, every person is a kingmaker."

Last week's back-and-forth in the Senate was emblematic of a process that has at times seemed on the brink of anarchy. Even close allies of the White House sometimes questioned its approach.

"It felt like it was getting out of control at the end of July and in the beginning of August," said John D. Podesta, a former chief of staff to President Bill Clinton who informally advises the Obama White House. "People were getting nervous that it was going every which way." Podesta said the president risked "giving too much rope to a Congress that is liked a lot less than he is."

Obama said early on that he would not repeat the mistakes of Clinton, who wrote his own detailed plan, only to see it fall flat on Capitol Hill. Instead, the president set out broad principles.

The president's distance caught congressional Democrats by surprise. It took them months to realize Obama would not weigh in on some issues, like the precise shape of a government insurance plan. One House Democrat called it "a laissez-faire strategy."

But in an interview Friday evening, Emanuel — joined by other top members of Obama's health-care team — disputed that characterization. He said the White House had given "leeway to legislators to legislate," but "not leeway to take a policy off track."