As health care reform officially hits its one-year mark this week, the process of getting legislation passed has boiled down to one simple question: can leadership in the House of Representatives muster the votes?
Over the past few days, officials in both chambers of Congress and the White House have surveyed the landscape and come to a rather dispiriting conclusion. As things stand now, there isn't a majority of Democratic representatives to support the bill as written. The count should change once amendments are presented but currently top aides in the House concede that Speaker Nancy Pelosi (D-Cali.) is short by anywhere from six to 12 members.
To convince these lawmakers, House leadership is preparing a whip operation described as "all hands on deck." Pelosi and Rep. James Clyburn (D-S.C.) will dispatch loyal lieutenants to help rub elbows and twist arms. Once the party settles on a final set of reconciliation changes, leaders in the labor community are set to launch a major campaign to help with the whipping, officials say.
Through it all, the administration will offer substantial assistance, sending its legislative team, including Chief of Staff Rahm Emanuel, to the Hill and bringing lawmakers to the White House to meet with the president.
But the tools at their disposal are limited. Traditionally, leadership would place sweeteners in a bill to draw out a lawmaker's vote ($50 million for highway funds here, an earmark for a special project there). But when the Senate used that tactic to win over conservative caucus members this past fall (such as the infamous Cornhusker Kickback), it became a major embarrassment for the party. And now, the White House and House are rejecting any more backroom deals.
"This is a process that is designed to take the pot-sweetening out of the process that got involved in the process at the end of December," White House spokesman Robert Gibbs said on Wednesday, during a briefing with a small number of reporters. "What we are trying to do is focus on what is important for getting this policy right and convincing those in Congress that this proposal is the right one for their constituents."
In place of sweeteners, the next logical alternative is intimidation: sending the president to a fence-sitting congressman's district or threatening future legislative projects. But the White House has been disinclined to use this tool as well. "We are NOT going to threaten members," Gibbs stressed, though hinting that Obama will travel outside D.C. to sell the bill. Besides, strategists with experience at working votes in the House don't think such a strategy would work.
"My experience in intimidation is that it is pretty hard to do, especially in this environment," said Steve Elmendorf, a one-time senior adviser to House Democratic Leader Dick Gephardt. "What are they going to intimidate with? It seems to me you are operating from a position, not of weakness, but you have a threatened majority, you have a bill that is not really popular that you have to sell. So I don't think there is much to threaten with."
Lacking these tools -- or the willingness to use them -- the process of rallying members behind health care reform has become a frustrating one for Democrats. And it's made even trickier by the fact that opposition is coming from several different factions of the party. Fiscal conservatives are unhappy with the bill's costs, pro-life lawmakers don't like its abortion language and progressives don't think the legislation goes far enough. "The no votes aren't in one particular camp," said one aide.
But leadership isn't entirely stymied. For starters, not all sweeteners are out of play. While lawmakers are reluctant to place legislative gifts inside the health care bill, they could hang them outside of it. On Wednesday, the White House nominated the brother of Rep. Jim Matheson (D-Utah) -- a targeted health care vote -- to the United States Court of Appeals for the Tenth Circuit. Gibbs insisted that it was "very silly" to interpret the nomination as a quid pro quo. But sober-minded political practitioners acknowledge that these deals might be necessary to get legislation passed.
"You have to go to things unrelated to the bill," said one well-connected Democratic strategist. "What committee do you want to be on? What other unrelated piece of legislation are you pushing?"
At this point, it seems, the White House prefers to rally lawmakers by focusing attention on the compelling big-picture narrative than by relying on smaller, more specific side issues. Meeting with Democratic officials, the president and his team (echoed by allies in the House) are stressing first and foremost that the party's future is at stake.
"They are saying this has to get done," said a top House aide. "That we have to do this, for the good of the party. It is beyond, simply, 'We need to pass this because it is the right thing.'"
Aides say the goal is to create a climate in which skeptical lawmakers are no longer hesitant to approach the bill -- but much of that will only happen after leadership settles on final reconciliation fixes. Indeed, few of the fence-sitting lawmakers are expected to announce their voting intentions until they know what the final legislation will resemble and whether or not it will pass the Senate. This means getting word from the parliamentarian and assurances from Majority Leader Harry Reid (D-Nev.). On this front at least, the past week -- in which even the institutional purists seemed content with the proposed reconciliation fixes -- was a good one.
"We don't have legislative language so we can't know for sure where those on the fence are going to come down," said one House leadership aide. "But we do have an environment where people can now get to yes."