Starting Points: Congress

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Apr 1, 2010

Republicans Move Ahead in 2010 Vote for Congress

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Republicans Move Ahead in 2010 Vote for Congress

Feb 27, 2010

Pelosi’s Challenge - Corraling Votes for a Health Bill

By SHERYL GAY STOLBERG and ROBERT PEAR

WASHINGTON — The future of President Obama’s health care overhaul now rests largely with two blocs of swing Democrats in the House of Representatives — abortion opponents and fiscal conservatives — whose indecision signals the difficulties Speaker Nancy Pelosi faces in securing the votes necessary to pass the bill.

With Republicans unified in their opposition, Democrats are drafting plans to try on their own to pass a bill based on one Mr. Obama unveiled before his bipartisan health forum last week. His measure hews closely to the one passed by the Senate in December, but differs markedly from the one passed by the House.

That leaves Ms. Pelosi in the tough spot of trying to keep wavering members of her caucus on board, while persuading some who voted no to switch their votes to yes — all at a time when Democrats are worried about their prospects for re-election.

Representative Dennis Cardoza, Democrat of California, typifies the speaker’s challenge. The husband of a family practice doctor, he is intimately familiar with the failings of the American health care system. His wife “comes home every night,” he said, “angry and frustrated at insurance companies denying people coverage they have paid for.”

But as a member of the centrist Blue Dog Coalition, Mr. Cardoza is not convinced that Mr. Obama’s bill offers the right prescription. It lacks anti-abortion language he favors, and he does not think it goes far enough in cutting costs. So while he voted for the House version — “with serious reservations,” he said — he is now on the fence.

“I think we can do better,” Mr. Cardoza said of the president’s proposal.

Representative Frank Kratovil Jr., Democrat of Maryland, is also unconvinced. He voted against the House bill on the grounds that it is too big and too costly — a view that some constituents in his Republican-leaning district share. In case he did not get the message, one of them hanged him in effigy this past summer outside his district office on the Eastern Shore of Maryland.

“This system is broken; we have to do something,” Mr. Kratovil said. “But my preference would be to do smaller things.”

For the moment, there is no actual bill. The tentative plan calls for the both the House and the Senate to use a parliamentary device known as reconciliation to pass a compromise measure.

The tactic is intended to avoid a Republican filibuster, but in the Senate, the majority leader, Harry Reid of Nevada, faces challenges if he tries to use it. He is having trouble persuading a majority of his caucus to go along.

In the House, lawmakers like Mr. Kratovil, Mr. Cardoza and other swing Democrats will come under increasing scrutiny from leadership as a vote draws near. Of the 219 Democrats who initially voted in favor of the House measure, roughly 40 did so in part because it contained the so-called Stupak amendment, intended to discourage insurers from covering abortion.

Some, notably Representative Bart Stupak, the Michigan Democrat for whom the amendment is named, will almost certainly switch their yes votes to no because the new version being pushed by Mr. Obama would strip out the House bill’s abortion restrictions in favor of Senate language that many of them consider unacceptable.

An additional 39, like Mr. Kratovil, are fiscal conservatives who voted no the first time around. Ms. Pelosi is hoping that she can get some to switch those no votes to yes in favor of Mr. Obama’s less expensive measure.

But persuading Democrats who are already on record as opposing a health overhaul to do a turnabout will not be an easy task, especially during a midterm election year in which Democrats’ political prospects already look bleak. Of the 39 Democrats who voted against the House measure, 31, including Mr. Kratovil, represent districts that were won in 2008 by Senator John McCain of Arizona, Mr. Obama’s Republican rival. Fourteen, including Mr. Kratovil, are freshmen, who are generally considered more politically vulnerable than more senior lawmakers.

“The concern among Democrats right now is that there are more yes votes reconsidering than no votes,” said David Wasserman, who tracks House races for the nonpartisan Cook Political Report. “My sense is that for Democrats to pass this bill, they would have to convince several members who are already in serious jeopardy, even after voting no on the first health care bill, to put passage of the bill ahead of their own chances of being competitive in the fall.”

But politicians do not want to be martyrs. They want to hold onto their seats.

Ms. Pelosi is facing resistance from some of her most senior members, like Representative Ike Skelton, Democrat of Missouri and chairman of the Armed Services Committee. He has been in office since 1977, but is facing his toughest re-election challenge in years.

Mr. Skelton says he does not see any improvements in the measure that would cause him to vote in favor of it; like Mr. Kratovil, he favors a smaller, less ambitious bill. “It would be a lot easier,” he said, “if we cut this back to basics — take two or three or four issues on which everyone agrees and build on it.”

Others, like Representative Jason Altmire, a Pennsylvania Democrat who also voted against the House bill, seem to wonder aloud why Mr. Obama is bothering. With so many Democrats feeling nervous about their past votes in favor of the health bill, Mr. Altmire said, he can imagine vote-switching in only one direction: from yes to no.

“I don’t know of any no votes at this point that would switch unless the bill is substantially changed, including me,” he said. “And I know of a handful of yes votes who regret it and would relish the opportunity to put a no vote on the board so they could go back home and talk about that.”

Analysts like Mr. Wasserman say Ms. Pelosi’s best chances for no-to-yes conversions rest with Democrats who are retiring, because they do not have to worry about their political fortunes in the fall. So far, there are only three: Representative John Tanner and Representative Bart Gordon, both of Tennessee, and Representative Brian Baird of Washington.

Mr. Tanner has told colleagues he has no intention of switching his vote, according to one Democratic lawmaker who has spoken with him. And in interviews on Friday, Mr. Gordon and Mr. Baird sounded decidedly noncommittal.

Mr. Gordon said his constituents were “starting to get a little bit tired” of hearing about health care. He said he wanted to see “at least a partially bipartisan bill” — something that now seems impossible in the House, given that the lone Republican who voted in favor last time, Representative Anh Cao of Louisiana, has publicly changed his mind.

Mr. Baird said he was ”totally undecided” about whether he could support the new version taking shape in Congress, though he did say the bipartisan forum Mr. Obama conducted at Blair House on Thursday would “potentially” make him more likely to vote for the legislation, perhaps because Republicans seemed so dug in against it.

“At several points,” Mr. Baird said, “President Obama tried to find common ground, only to see the other side go back on message.”

Publicly, House Democratic leaders are trying to sound upbeat. The House Democratic whip, Representative James E. Clyburn, Democrat of South Carolina, said last week that he felt ”pretty good” about the chances of passing Mr. Obama’s bill. But the leadership has not yet started counting votes, and a senior House leadership aide, speaking on condition of anonymity, conceded that rounding them up would not be easy.

“It’s going to be a heavy lift,” this aide said, ”but so have many other votes. In the last health care vote we really didn’t have the majority until the afternoon, and this will probably be that way too. That’s how these votes come together in the end.”

Carl Hulse contributed reporting.

Feb 23, 2010

Is There Life in Health Care Reform?

By Elizabeth Drew

In politics, as in life, there's often a very fine line between a fluke and an earthquake. They can even be mistaken for each other. In many ways, Scott Brown's upset victory over Martha Coakley on January 19 for the Senate seat long held by Edward M. Kennedy, just as Congress was nearing agreement on the health care bill, was a fluke. The confluence of seemingly unrelated events had more impact than any of them would have had individually. Even the date of Kennedy's death last August had major consequences: if it had happened a month later, the President might already have signed a health care bill into law by the time the election was held. A senior Democratic House strategist told me, "Had we known that Massachusetts was in play, we'd have worked through the Christmas break and might well have been done before the election." The bills passed by the House on November 7 and by the Senate on the day before Christmas were quite similar. (Nancy Pelosi and Harry Reid and their aides, in consultation with the White House, had seen to that.)

As a result of intensive negotiations in early January, the bills were more than 95 percent alike by the time of the Massachusetts election. Two major issues remaining had to do, first—thirty-seven years after the Roe decision establishing abortion as a constitutional right—with Congress having adopted provisions in the health care bill that make it difficult (the Senate) or even impossible (the House) for women who received federal help to purchase abortion coverage with their own funds (really!); and, second, with excise taxes on the more expensive ("Cadillac") plans, which labor objects to.

Republicans had applied the theory that the longer a bill is delayed, the weaker it becomes. Their real goal was to kill it. They gave Senate Finance Chairman Max Baucus just enough encouragement that he engaged in a months-long effort to get Republican backing for the bill. The idea, shared by the White House, was that a bill with bipartisan support would have more legitimacy with the public; but the negotiations kept going long after it was clear that the Republicans didn't want to help. (He got the vote in committee of Maine's Olympia Snowe, who made a big show of her reluctance to give it—the diva who wouldn't leave the stage—and then voted against the bill on the Senate floor.) Finally, even the White House gave up on Baucus and scheduled Obama's speech to Congress on health care on September 9, to encourage his committee to wrap it up. By the time the Senate finally passed its bill on Christmas Eve, Coakley was losing altitude, but no one seemed to notice.

An election outcome is usually caused by a number of factors, but national observers tend to look for national implications. In fact, Coakley broke a fundamental rule of running for office. Having swept the primary, she took the final election, five weeks later, for granted. As a Democratic senator said to me afterward: "There's a saying that there are only two ways to run: unopposed or skeered." He added, "She wasn't unopposed." Though she had run for the nomination on the fashionable demand for "change," the handsome, sly, and wily Brown beat her at her own game. Because no one realized in time that it was a real race, there were no exit polls, but a telephone survey by the highly respected Hart Research Associates on the night of the election called it "a working-class revolt," saying that the survey "reveals to Democrats [the cost]of not successfully addressing workers' economic concerns." Yet the survey also concluded that by a two-to-one majority, voters said they decided on the basis of the candidate, not because they were "sending a message to Washington."

The Hart firm also interpreted the results as "not a call to abandon national health care reform," pointing out that "Brown actually lost among the 59 percent of voters who picked health care as one of their top two voting issues." It was another fluke that Massachusetts was the only state with a comprehensive health care program, which Brown had supported, but he said therefore he didn't want the people of Massachusetts to pay for the health care of people in other states.

Nevertheless, many people jumped to the conclusion that the election was a rejection of the pending health care bill. The bill itself, its perceived shortcomings and flaws notwithstanding, stood to be the greatest advance in health care coverage for Americans in decades, if not ever. At least 30 million more people would receive coverage; those who could not afford health insurance would receive subsidies; those with coverage would be relieved of the worst depredations of the health insurance industry, such as rejecting people on the grounds that they had "preexisting conditions" or cutting off care of a patient because it was becoming too costly. Access to Medicaid would be significantly expanded. Presumably a start would be made on getting some control over the ever-burgeoning health care costs to this country. Moreover, it could be the last chance for significant health care reform for a long time.

Even before the Massachusetts election, it was evident that progressives were probably at the peak of their political power for some time to come: typically, the party of first-term presidents loses seats in the midterm elections, and the outlook for the Democrats in 2010 was already ominous. Elections in 2009 for governor in Virginia and New Jersey, as well as various polls, indicated that independents, who had swung the 2008 election to Obama, were leaving the Democrats in droves. And the closer a controversial bill gets to the midterm elections, the more the incumbents become uneasy about it. This is why Obama, who had campaigned hard on the issue, made it his first domestic priority; key figures on Capitol Hill told the White House that it was reasonable to expect Congress to pass it by August 2009.

Even though until the Massachusetts election the Democrats held sixty Senate seats (the first time a party had done so for thirty years)—just enough to shut off a filibuster—the Democrats themselves were divided in their degree of support for the bill, with some seeming opposed, and some, such as Blanche Lincoln, of Arkansas, facing daunting reelection challenges, while the Republicans were united against it. Therefore, Harry Reid and the White House had very little room to maneuver. And while Nancy Pelosi had a more progressive caucus, it was not enough to get bills through the House without the support of some moderate or conservative Democrats. (Hence she had to accept the harsh anti-abortion restrictions of the cartoonish Congressman Bart Stupak of Michigan.) In sum, in the Senate we have a parliamentary system, which depends on party discipline, but not majority rule; it's not a workable system.

Therefore, while the health care bill could be changed at the margins, at some point the question became not whether the bill would meet most of the progressives' expectations but whether there would be a bill at all. It was a lot easier for progressive critics to attack the bill, and say that it should be significantly changed—arguing in particular that it should not rely so much on the flawed existing private insurance system—than it was to find sufficient votes to change it. The bill that emerged from the Senate probably went about as far as could be expected, in view of the political realities. Sheldon Whitehouse, a freshman Democrat from Rhode Island who is widely seen as increasingly influential in the Senate, told me, "The vast majority of Democratic senators pushed the more conservative members of the caucus about as far as they could be pushed. We couldn't get any more from our more insurance-oriented members." As for Obama's role, Whitehouse said, delicately, "I don't think the President would add much to the equation. I think the internal pressures of the caucus took it about as far as it could get."

Yet numerous critics in and out of Congress publicly denigrated the bill for not going far enough. Howard Dean, who obviously delighted in the television attention he was getting, and who certainly should have understood the reality, called the Senate bill without the much-discussed public option (for which it was clear from the outset that there weren't enough Senate votes) "a farce." In mid-December, he urged, recklessly, that the Senate should set the bill aside and start over. Under pressure from annoyed Democrats, he backed off.

Opinions about the significance of the public option were mixed. Some influential reform advocates didn't believe that it was so critical, and thought that its advantages could be made up in other ways, in particular through rules governing the insurance exchanges that were to be set up—but they didn't want to say so out loud for fear of alienating the Democratic left. Even some senators who preferred the public option but knew that there weren't the votes for it said privately that it had been made into an "icon," blown out of proportion. This was the calculation that Obama made: he sometimes gave it lip service in order to appeal to his base, but never really fought for it.

The Republicans had decided even before Obama was sworn in that they would use the rules to deny him success on every major issue. Such obduracy was without precedent in modern times. Even if they hadn't gone that far, it would have been impossible for Obama to achieve the bipartisanship he had so easily and naively promised in the campaign. The days of bipartisanship were already long gone. For sociological and political reasons, the electorate had changed; the center had just about disappeared. Former Senate Majority Leader Tom Daschle says that the last time the Senate acted in a spirit of comity was in the 1980s. The situation of 2009–2010 is different: it's not a matter of the two parties being unable to compromise on the substance of policy; it's a matter of one party deciding to deny the other any political achievements at all.

A stunning example occurred in late January. After Obama said he would support a proposed bipartisan fiscal commission, which would recommend politically difficult cuts in the federal budget, to be voted up or down by Congress (along the lines of the base-closing commission), seven Republicans who had sponsored the proposal actually voted against it—enough to defeat it. Obama said he would set up a commission by executive order, but it won't have the same power, and some key Republicans announced that they would boycott it.

Because of the filibuster rule, it's been assumed for many years that anything controversial, even bringing up a bill for debate, needs sixty votes (sixty-five until 1975). In the past, filibusters, or threats of them, had been made by a faction of the Senate, or of a party, or by representatives of a region (Southerners opposed to civil rights bills), and motions to end filibusters were usually bipartisan. When the health care bill was before the Senate, with all the Republicans lined up against it, the Democrats' needing sixty votes meant that every single member of the Democratic Senate caucus was a potential king or queen. Each senator was in a position to make demands, or to threaten to kill the bill. More of them behaved this way—putting themselves ahead of the greater good—than might have been expected. Each time, the White House and the Senate leadership had to decide between accepting an undesirable amendment or letting the bill die.

The Republicans have long been more respectful of hierarchy than the Democrats; this tendency was greatly enhanced after Newt Gingrich and his allies took over the House in the 1994 midterm elections and methodically accrued more and more power to the Speaker's office. As Gingrich's acolytes moved to the Senate in large numbers, they took with them their ways of exercising power and their scrappiness, their disdain for traditional Senate comity. And the Senate Republicans have their own ways of enforcing discipline. In mid-December 2009, Republicans were threatening to filibuster the defense appropriations bill for the acknowledged purpose of delaying consideration of the health care bill, which was to follow. (They were thus holding up pay and supplies for the troops fighting in Iraq and Afghanistan; if the Democrats did that, they would be charged by the Republicans with treason.)

The Democrats believed that they had a deal with Thad Cochran of Mississippi, the senior Republican on the Defense Appropriations Committee and widely admired as a courtly and honorable man, to adopt some amendments he wanted to the defense bill; in return he would provide the sixtieth vote to shut off the filibuster on defense appropriations. (One Democrat was holding out on this vote.) But then the Senate Republican leaders, in particular the dour whip John Kyl of Arizona, leaned heavily on Cochran, telling him that the Republicans had to stick together and make the Democrats come up with their own sixty votes. "It was kind of an agonizing ordeal for me," Cochran told me later.

In some instances, Republicans who might shun the leaders' demands are given indications that their future committee assignments might be affected; and they can be made to feel very lonely in conference meetings. Cochran's Democratic colleagues watched in amazement as the last man they thought wouldn't keep his word quietly raised his hand to cast his vote (he couldn't even say it) against shutting off the filibuster on the defense bill, and quickly left the Senate floor. If the Republican leadership is willing to treat Cochran—who is third in seniority among Senate Republicans and would be chairman of the Appropriations Committee if the Republicans were in the majority—in this way, it's not hard to imagine how more junior members are treated.

The President, his aides, and other leading Democrats were already aware that rage was building among voters as a result of the same facts that were frustrating the administration: despite all its efforts, the bailouts, and the stimulus, unemployment remained high. Though gains had been made, fear that the recovery wasn't real was holding it back. A major economic adviser to the President told me not long ago that by November 2010 unemployment might well reach above 10 percent because, as the economy presumably improved, more people who had stopped looking for work would reenter the job market.

Though Obama had in fact achieved more than any recent president in his first year in office, and his personal popularity remained relatively high, his approval rating was falling fast, and he was widely seen as a failing president. Obama was getting more criticism than credit for his actions to keep the economy from falling into a depression—a subject that hadn't come up in the campaign—and in his State of the Union address in late January he distanced himself as far as possible from the bank bailout. ("I hated it. You hated it.") Still, White House aides understood that—"not without reason," one adviser told me—much of the public saw the Obama administration, as the saying went, as more concerned about Wall Street than Main Street.

Some of Obama's achievements were simply lost in all the hubbub over the health care bill. Some were simply confused with one other (many thought the stimulus bill and the bailouts were the same thing). Obama was proving at risk of fitting that most dangerous of political descriptions: a disappointment. His campaign aides had portrayed him as a "transformational figure" who would have a vast following ready to march for him, helping him pass his legislation. But this following didn't materialize once he came to office, in part because people who had set aside time to help him win the presidency had other things to do with their lives, in part because the Obama administration has been neither well organized nor effective at summoning the predicted following for his programs. Obama seemed to have lost his magic.

There's no question that the health care bill was sinking in popularity before the Massachusetts vote (but it was not, as Brown said recently on ABC's This Week, "on its last legs"). The interesting question is why it was losing support. In an NBC/Wall Street Journal national poll shortly before the Massachusetts election, only 33 percent of the public approved of Obama's health care plan. Yet this same poll indicated that 40 percent of the respondents wanted reform efforts to do more, not less. My own view is that it was their impression of what happened as much as what actually was going on that caused so many people to turn against it. The process became confused with the substance. The analogy between legislating with sausage-making fits here particularly well—"People who love sausage should never see it made." The legislating on the health care bill was widely followed in the media; people saw the sausage being made.

Moreover, a number of people behaved very badly, showing for all the world to see that they put themselves ahead of the greater good. (Not all did, by any means, but enough to disgust the public.) Getting attention and taking home as much bacon as possible (even at the expense of other states and the bill itself) and ideological posturing (pushing for something that had no purpose except being divisive and getting the legislator proposing it on television as a result) were too much in evidence. Inevitably, much of the public became fed up—forgetting the purpose of the whole enterprise. Perfectly intelligent people told me that they no longer cared whether the health care bill passed after Ben Nelson of Nebraska, a conservative Democrat (and former insurance executive) who used his necessary sixtieth vote to great advantage (he had already been complicit in modifying the stimulus bill for the worse), arranged to get his state exempted from paying fees for the expanded Medicaid program. (This followed the "Louisiana Purchase" by which Mary Landrieu obtained an extra $300 million in Medicaid money for her state.)

People shocked by these arrangements overlooked that such deals, if not of this magnitude or open brazenness, take place all the time. But the Nelson deal caught people's attention and blew it out of proportion; watching the health care bill move through Congress was like being in a hall of mirrors in a fun house. Everything, it seemed, was distorted. Nelson, however, got flack from his own state because he had gone too far, and after a while tried to get rid of the amendment, but because of the legislative impasse he was stuck with it. What were Senate leaders or White House aides thinking about when they accepted Nelson's ransom demand? Or Joseph Lieberman's rejection of a proposal to expand Medicare coverage? (Lieberman, though he got there first, was not alone in his opposition.) They were asking themselves, one of them told me, whether it was worth rejecting these proposals, only to lose the bill.

But citizens who were so turned off by the Nelson deal that they were ready to give up on the health care bill weren't adequately informed about the bill itself, and this gets back to the treatment of the health issue in the press and on television and the Internet. The Nelson story was a big story; what was in the health care bill was not. The messiness and the anger on Capitol Hill were the story. The media also had a large part in polarizing the public over the bill. As cable outlets and blogs become more ideological, on both the left and the right, people have become more inclined to seek out the ones they agree with. And the outlets stir up ratings through exaggeration and combat.

Though Obama never submitted his own bill—which might have helped but he didn't want to be seen losing on some of its provisions—he said again and again what he wanted the health care bill to be, or what it was, but the press didn't think that was news. What good the bill would do, even what it would do, didn't fit in with the story the press wanted to tell. The people who appeared most often as guests on television—to the point of aching tedium—were those who had objections to the bill, particularly those on the left such as Dean, and Anthony Weiner, a New York House member, who complained repeatedly about the absence of the public option, long after it was clear that the Senate wouldn't accept it; and the Socialist-Independent Bernie Sanders, who clung to the fantasy of turning the whole thing into a single-payer system. One unfortunate upshot of Obama's decision not to get very involved publicly until the final negotiations was that his presidency became too defined by the goings-on on Capitol Hill, the deal-making. The clear impression was that Obama was not leading.

Obama's and his administration's performance on the day after the Massachusetts Senate election was dismaying. Obama told George Stephanopoulos in an ABC interview that morning that the White House had seen Coakley's loss coming for a week, but they clearly weren't prepared. They lacked both talking points and strategy, and the result was a mess. First, the President mentioned a legislative procedure, although no one knew what he was talking about, and then he made matters worse by suggesting that the bill might have to be pared down to its more popular parts, which was not only an early retreat but would be more difficult than it sounded, because the bill's main parts were in equipoise.

Popular insurance reforms, such as guaranteeing that no one would be rejected because of preconditions, were interconnected with ways to pay for them—by guaranteeing insurance companies more customers, which required a mandate to buy insurance policies. This, in turn, would require subsidies for those who couldn't afford insurance. Obama's press aides spent the rest of the day cleaning up after him, by saying that the President still preferred that Congress pass a major health care bill. The absence of a clear statement from the White House led panicked Democrats on Capitol Hill to make contradictory and often incoherent comments.

A similar thing happened with the President's speech to a Democratic National Committee meeting on February 4, in which he suggested a time-consuming process, and the possible outcome that the bill could die. Once again, aides had to fan out to clarify that Obama still wanted a bill, and I'm reliably told that there are meetings at the White House every day on how to salvage the bill.

The problem isn't, as this White House, like many before it, concluded, that it wasn't "communicating": it communicates all the time, sending aides out to deliver messages on talk shows and putting the President before the cameras (and TelePrompters, which should go) all the time. The problem is that they convey contradictory messages and that the President is far better at rhetorical eloquence than he is effective at explaining what needs to be done. He sometimes ruminates—and gets in trouble. White House aides complain that the press "overinterprets" what the President says, but by now the Obama White House should understand that that's how it works.

And Republicans seem to win the "talking points" time and again. The wise Vin Weber, a former Republican congressman and now a lobbyist, says that the problem isn't that the Republicans are so much better than the White House at creating "talking points," but that "it's very difficult to put together positive talking points on health care. It's very complicated. In fact, it's very hard to find a time when health care was a winning political issue." Weber recalled the famous incident when, after Congress in 1988 had passed a bill to provide Medicare coverage, for a fee, for catastrophic care, House Ways and Means Chairman Dan Rostenkowski, its chief sponsor, was chased away in his car by an angry Chicago mob; three months later the bill was repealed. So administrations trying for health care reform tell themselves, as the Obama administration has done, that people would like the bill when it came into effect and would then stop focusing on the bad things it might do.

Mostly for financial reasons, however, the main part of the current health care bill wasn't to go into effect until 2014. So the administration came up with a list of "deliverables"—advantages they could give people before then. But through repetition and lies, the Republicans were winning the propaganda debate. Time and again, they spoke of a "government takeover of health care." On the night the House passed the bill, Minority Leader John Boehner engaged in a long rant that included warnings that people would go to jail if they didn't buy health insurance. Meanwhile, the White House's rationale for the bill wandered from being a way to reduce the deficit, to a way to protect consumers, to a moral imperative, to, more recently, something that would produce jobs.

By the time of the State of the Union address, the President and his aides had wanted to "pivot" from health care to legislation to provide more jobs; the dragged-out consideration of the health care bill had been agonizing for them, as well as politically damaging. So he pivoted anyway. Advocates of health care reform complained; but in the midst of all the commotion about the Massachusetts election and the evidence of a working-class revolt, Obama would have looked like the doofus he isn't had he led off with yet another argument for health care. But he insisted that he hadn't given up on it, because not to succeed would be a political disaster for him—and as he pointed out in the speech, "I know this problem is not going away."

Obama was also criticized for not laying out in his speech a strategy for how to get a final health care bill, but there was no strategy. By this time, the House and the Senate, between which there have long been institutional tensions, were nearly at war. The House had passed some politically difficult bills (cap and trade to lower carbon emissions, regulatory reform of Wall Street, another jobs bill) that were lying dormant in the Senate. House Democrats were steamed up and threatening not to take up certain bills, such as immigration reform, until the Senate had done so.

Now that the Senate Democrats had lost their sixtieth vote, working out a final health care bill had become vastly more difficult, as a number of other things promised to be. (To rub it in, Scott Brown got himself sworn in a week earlier than planned, on February 5.) Without sixty votes, the Democrats couldn't simply reopen the Senate bill to incorporate the changes that the Democratic House and Senate leaders had agreed upon. Instead, the Senate Democrats wanted the House to adopt the Senate bill, and then both chambers would adopt a "reconciliation" bill (which would require just fifty-one votes in the Senate) that would include most of the final changes.

But House Democratic leaders, mistrusting the Senate—and not liking it, either—balked at doing that. Pelosi stated definitively that she couldn't get enough House votes to pass the Senate bill, unless the Senate passed the reconciliation bill first. And the Senate said that the rules made it impossible to adopt the reconciliation bill first (the House disagreed). Some of the changes couldn't be put in the reconciliation bill, which can only deal with matters that affect the budget. This would call for a third bill, which no one knows how to pull off.

Logically, there should still be a way to get a bill passed. But logic went out the window on January 19. The situation was as much psychodrama as legislative stalemate. The perfectly reasonable argument was made to Democrats in Congress, mainly by the administration, that, having voted for the bill already, it would be worse for them to fail to pass it than to pass it, but this seemed not to be heard. If Obama didn't exert himself for the bill on which he'd spent most of his time in office thus far, it would be not just a political catastrophe for him but leave a scar on his presidency. Longtime observers—members of Congress and people who deal with them—say they have never seen such a sour mood on Capitol Hill, affecting both members and staff alike. One longtime Democrat said to me recently:

The moderates are paranoid, the liberals are upset, the leaders are frustrated and losing the trust of everybody. There's no level of trust between the Senate and the House or the White House and everyone else. There has been a breakdown of the kind of chemistry you need to get this kind of thing done.

The opportunity might have been lost as a result of a misreading of a fluke in Massachusetts. To successfully remedy this misreading would require a certain amount of will, but, at least in the Senate, whatever will had been present appears to be fading. A senior Senate Democratic aide said to me at the end of the week after the election, "There isn't a member of our caucus that isn't concerned after what happened last week." A few days later the same person sent me the following e-mail:

Every option is bad. The leaders in the House and the Senate want to get a bill but enthusiasm is waning in the rank and file. They want us to focus on jobs. Still think we can get it done but have no idea how.

Obama's move to take the issue to the Republicans by inviting them to a half-day, bipartisan meeting at Blair House on February 25 to discuss health care—without, as the Republicans had been insisting, scrapping the pending bill and starting over—was intended to show the public (and wobbly Democrats) who the obstructionists are. (And Obama's recent televised meeting in Maryland with House Republicans had been a big hit.) The invitation was also intended to answer public criticism, now registering in the polls, of "backroom deals" (Landrieu, Nelson) and Republican taunts that Obama hadn't followed through on his ill-considered campaign pledge to put health care negotiations on C-SPAN. (That's not the way real negotiations get done, and Obama, new to national politics, probably never dreamed he'd be taken seriously. Or he spoke without thinking.)

The Republicans believe that their strategy of denying Obama legislative victories is a winning one. If the meeting on February 25 doesn't lead to a serious bill, White House aides made it clear that the President would go ahead and try to get a health care bill anyway. Somehow.

—February 9, 2010

Jan 21, 2010

After Massachusetts loss, Democrats vow to focus on economy, jobs

Image via Wikipedia

By Dan Balz and Paul Kane
Washington Post Staff Writer
Thursday, January 21, 2010; A08

A day after their embarrassing loss in Massachusetts, splintered Democrats pledged to refocus their attention on jobs and the economy, and to draw sharper contrasts with Republicans, as they scramble to find a strategy to quell the populist anger that threatens the party's standing in the November elections.

Elected officials and Democratic strategists found little common ground, however, in the specifics of their response to their party's shellacking in Massachusetts, whether on how to proceed with a health-care bill that has become a political liability or on the elements of a jobs program that can dent the unemployment rate.

But they did agree that voters are prepared to punish them, not only because the economy has not improved faster, but also because they have not delivered on one of the central promises of President Obama's campaign: changing the way Washington does business.

Former Democratic National Committee chairman Howard Dean said the proper course for Democrats now "is exactly the position the president took when he ran," which Dean said was to pledge that special interests would not run the government under his administration. "What voters think, unfortunately, is that they do run Washington," he said.

Pennsylvania Gov. Edward G. Rendell said it was "just wrong" to interpret Republican state Sen. Scott Brown's victory over Democratic state Attorney General Martha Coakley in Massachusetts as a crushing defeat for the president, citing the vagaries of special elections and the difference in the quality of the two campaigns.

But he said Democrats must urgently begin to deliver on their promises in order to head off sizable losses later this year. "Let's give people a reason to turn out and vote for us," Rendell said. "Let's pass a jobs bill. Let's pass a health-care bill. Be a party. Stand up and get things done."

A focus on independents

Sen. Robert Menendez (N.J.), who as chairman of the Democratic Senatorial Campaign Committee helped oversee Coakley's losing bid, said the key political ambition in the next 9 1/2 months is to "make sure we find a way to engage independent voters."

Coakley ran poorly among independents, according to pre-election polls, continuing a trend that surfaced in Virginia's and New Jersey's gubernatorial elections last November, when such voters deserted Democrats and backed Republicans.

But Menendez's House counterpart said focusing primarily on independents is a false choice that could leave the party's left flank demoralized and on the sidelines in November.

Rep. Chris Van Hollen (Md.), chairman of the Democratic Congressional Campaign Committee, said the party must find a way to pass a health-care bill, which would help soothe anger among liberals who feel slighted by the agenda so far, and should push an economic program that appeals to independents concerned about unemployment.

On Capitol Hill, Democrats are focused on the health-care conundrum -- whether they can quickly pass legislation and move on to other issues, principally the economy. "What we don't want to see is that this [health care] is to the exclusion of other things," said Sen. Benjamin L. Cardin (Md.), a leading liberal. "You have to be able to see the finish line. We're now at the last hurdles. You have to have a plan that can win."

Sen. Robert P. Casey Jr. (D-Pa.) said that he favors trying to finish health care but that it must be wrapped up quickly to allow a turn to a new agenda. "It's got to be jobs, almost exclusive of everything else," he said.

If the present climate holds through the fall, Pennsylvania Democrats face the prospect of losing the governor's mansion, a Senate seat and at least six House seats in November.

'It's our problem'

Delaware Gov. Jack Markell, chairman of the Democratic Governors Association, said there is considerable impatience among voters and Democrats must be responsive. "My sense of it is that people in power, whether federal or state, are seen as the people who are responsible," he said. "We have an affirmative responsibility to do so something about these issues."

Markell predicted that once the unemployment rate starts to go down, some of the anger in the electorate will ease. "Until then, it's our problem," he said.

The lack of consensus in the Senate about job creation complicates Democrats' desire to show the public that they are focused on the economy. "The tough part for Democrats is that it is a governance issue, a really substantive problem," said Bill Carrick, a California-based Democratic strategist. "The Republicans don't have to deal with it. All they have to deal with is, 'We don't like what they're doing.' "

South Carolina Democratic Party Chairwoman Carol Fowler said part of the party's problem is that "people voted for change, and change didn't happen the next day. . . . There are lot of people in this country who are miserable, who want something done. Voting people out, whether they've been in office a week or years, seems like the way to get change."

Fowler said Democrats must move more aggressively to hold Republicans accountable for their opposition to the administration's agenda, rather than changing the agenda.

Carrick agreed that drawing sharp contrasts is the key to survival for Democratic candidates this fall. He pointed to the 1994 elections, when Republicans rode anger at Washington and dissatisfaction with the Clinton administration to a landslide takeover of the House and the Senate. "The few that survived at the top of the tickets were campaigns that recognized the situation they were in and moved aggressively to frame the election as a comparative choice," he said.

Looking ahead to this fall, Carrick added, "This is not going to be a campaign where we're going to see people talking in lofty terms about the future of the country."

Jan 9, 2010

Obama Takes New Route to Opposing Parts of Laws

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By CHARLIE SAVAGE

WASHINGTON — The Obama administration is lowering the volume in a long-running argument between Congress and the executive branch over when, if ever, a president has the power to bypass federal statutes he has signed into law.

Legal scholars said the administration’s new approach, which avoids repeating claims of executive power that the White House has previously voiced, could avoid setting off fights with lawmakers. But the approach will make it harder to keep track of which statutes the White House believes it can disregard, or to compare the number of laws challenged by President Obama with former President George W. Bush’s record.

In Mr. Obama’s first months in office last year, he followed recent precedent and frequently issued statements, when signing bills into law, that the executive branch could disregard provisions that he considered unconstitutional restraints on executive power.

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But Mr. Obama has not issued a signing statement since last summer, when one claim set off a bipartisan uproar in Congress. And the administration has decided that Mr. Obama will sometimes sign bills containing provisions it deems problematic without issuing a signing statement that challenges those sections.

Still, the administration will consider itself free to disregard new laws it considers unconstitutional, especially in cases where it has previously voiced objections elsewhere, officials said.

The White House disclosed its shift when asked why it had not put out a signing statement last month, when Mr. Obama signed a $447 billion spending bill for 2010. It contained several provisions that restricted executive power in ways that the administration had previously asserted were unconstitutional — including in signing statements attached to similar bills and in policy statements it issued about the spending bill as lawmakers drew it up.

“The administration’s views about certain provisions in the omnibus spending bill had previously been publicly communicated,” said Ben LaBolt, a White House spokesman, “so it wasn’t necessary to duplicate them in a signing statement.”

Since the 19th century, presidents have occasionally used signing statements to declare that parts of a bill were unconstitutional and need not be enforced or obeyed as written. But the tactic was rare until the second term of President Ronald Reagan, whose legal team developed a strategy of issuing the statements more frequently to increase presidential power.

Reagan’s successors continued that approach. And the practice escalated again under Mr. Bush, who used it to advance expansive theories of executive power. He challenged about 1,200 sections of bills — more than all predecessors combined — including a ban on torture and oversight provisions of the USA Patriot Act.

Mr. Bush’s assertive use of the tactic set off a national debate over its propriety. The American Bar Association declared that signing statements “undermine the rule of law and our constitutional system of separation of powers,” and argued that the Constitution gave presidents only two choices: veto a bill, or sign it and obey all of it.

But other scholars said the tactic was appropriate if a president cited only mainstream legal theories. Mr. Obama, whose advisers sided with the latter camp, has characterized Mr. Bush’s use of signing statements as an abuse and pledged greater restraint.

Mr. Obama nevertheless challenged dozens of provisions early last year. The last time was in June, when his claim that he could disobey a new law requiring officials to push the World Bank and the International Monetary Fund to adopt certain policies angered Congress. The White House sought to reassure lawmakers that it intended to take those negotiating positions anyway and was merely noting its view that Congress cannot control foreign negotiations. Many lawmakers rejected that theory, and the House quickly voted 429 to 2 to bar officials from disobeying the restrictions.

Although the recent spending bill received no signing statement, it contained a similar provision about World Trade Organization negotiations, as well as several other types the administration had previously challenged. The White House issued several “statements of administration policy” warning that those provisions raised constitutional concerns while the legislation was pending, but Congress did not change them.

Representative Barney Frank, Democrat of Massachusetts, who led last summer’s backlash, said the White House risked losing Congressional support for international economic organizations. Mr. Frank also said it was “outrageous” to contend that if Congress disagreed with the administration’s opinion that a provision would be unconstitutional, the president could sign the bill and disobey it.

“They have a legitimate right to tell us their constitutional concerns — that’s different from having a signing statement,” Mr. Frank said. “Anyone who makes the argument that ‘once we have told you we have constitutional concerns and then you pass it anyway, that justifies us in ignoring it’ — that is a constitutional violation. Those play very different roles and you can’t bootstrap one into the other.”

But Peter M. Shane, an Ohio State University law professor, praised the approach as a step toward a return to the “normalcy” of how presidents used signing statements through Reagan’s first term. Mr. Shane has previously criticized the administration over its frequent early use of the device.

Still, Jack L. Goldsmith, a Harvard law professor who led the Justice Department’s Office of Legal Counsel in 2003-04, argued that an approach of issuing fewer signing statements would “not be terribly consequential” in practice because the executive branch could still override a provision that its legal team later pronounces unconstitutional.

Last year the Obama administration disregarded a statute that forbid State Department officials to attend United Nations meetings led by nations deemed state sponsors of terrorism. Congress has included that restriction in several recent bills.

When Mr. Bush signed one such bill, he issued a signing statement instructing officials to view the law as merely advisory, and they attended at least one such meeting on his watch. By contrast, when Mr. Obama signed another bill with an identical provision, he did not specifically single it out for challenge. But his administration later obtained an Office of Legal Counsel opinion pronouncing it unconstitutional, and officials continued to attend such meetings.

Unlike signing statements, opinions from the Office of Legal Counsel are often secret. Mr. Goldsmith said the administration’s approach of issuing fewer signing statements would mean “somewhat less accountability.”

“I think it’s a bad development if they are not going to highlight for the nation in all these new statutes where they think there are problems,” he said.

The White House, however, said it had given clear public notice about its views.

“Each piece of legislation,” Mr. LaBolt said, “is considered on an individual basis to determine whether a signing statement is necessary, and communications regarding the administration’s views on legislation such as Statements of Administration Policy will continue to be publicly available for Congress and all Americans to evaluate.”

Dec 30, 2009

Can Facebook, Capitol Hill be friends? Lawmakers learn social networking.

Image by Muhammad Adnan Asim ( linkadnan ) # 2 via Flickr

By Ian Shapira
Washington Post Staff Writer
Wednesday, December 30, 2009; C01

Inside the headquarters of the National Republican Congressional Committee, 25-year-old Adam Conner -- registered Facebook lobbyist, poster of multiple Obama attaboys and a guy whose Facebook photo is a grizzly bear wielding two chain saws -- sits to teach a course. The subject: How to use Facebook better. His student: Rep. Peter Roskam (R-Ill.).

"If we're going to improve our presence on Facebook and really maximize it, what would you recommend as tangible steps?" Roskam asks, thumbing his BlackBerry.

"It looks like you're very comfortable with your BlackBerry," Conner replies earnestly. "Maybe commit to a status message a day? A photo a week? Dive deeper. You'll be surprised at how things that seem routine to you as a congressman are so interesting and cool to constituents."

Conner is Facebook's evangelist in Washington, a social-networking pro summoned by elected officials and bureaucrats alike to teach them, free of charge, how to leverage Facebook -- within strict government rules and security guidelines. The mere existence of Conner's hand-holding lessons illustrates the cultural gulf between Washington and Silicon Valley, and spotlights the complex web of congressional rules that limit social networking among federal workers.

Conner is certainly grateful for his job as associate manager of Facebook's privacy and public-policy division. Compared with many of his highly educated but underemployed peers in Washington, Conner is doing just fine financially, earning about $75,000 a year, with equity to boot. (He declined to give specifics on his salary or stock options.)

But striver that he is, Conner, a 2006 George Washington alumnus who worked on Democrat Mark Warner's exploratory presidential campaign in 2006, chafes at his mechanic's role and the clash of cultures between Facebook's open-book attitude and Washington's need-to-know boundaries.

Image via Wikipedia

He's impatient for a time when he no longer receives as many as 20 help requests a day from government officials. "Everyone really wants to talk on the phone in D.C., and it's often not a polite request," says Conner, who is considering graduate school and entering politics one day. "It's often, 'Call me today.' Yeah, we have a 'Help' section on Facebook. It's very helpful. At the bottom of the page, it says 'Help.' "

On his own public Facebook page -- boasting 2,500 "friends," including many government officials -- Conner stays true to the transparency-is-king credo of the Internet.

One of his status updates earlier this month was this re-tweet -- the re-posting of another person's Twitter post: "RT @cjoh: Go outside. Feel that hail? That's God being pissed off at Joe Lieberman." Or, some days later: "Not a politics party till people start referring to previous hookups present by campaign cycle, like 'She was New Hampshire Primary 07.' "

His day job requires him to seek inroads with security-conscious government agencies and uptight lawmakers -- some of whom are looking into limiting Facebook's running room on privacy issues. But off the clock, Conner's Facebook page is unmoored from the Beltway ethic of caution.

Nor does Conner hold back on his partisan positions, a fact that does not seem to poison his relations with those on the right. Last week, Conner posted a link to a Web site devoted to mocking Republican National Committee Chairman Michael Steele, adding as preface: "this one is legendary."

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"He'll be sitting in my office and I'll ask him, 'Is your skin burning?' " said John Randall, the National Republican Congressional Committee's e-campaign director, who has requested Conner's help for two "campaign schools" this year designed to help Republican candidates improve their Facebook pages. "He just comes back and says, 'Hey, I am a businessman. I think you guys are wrong on a bunch of stuff, and other things not so much.' But I understand what he does. Facebook is a business and there are people who want to spend money on Facebook who are Republicans."

For a stronger democracy

Conner, who two years ago launched Facebook's Washington office out of his apartment and is now one of three employees in the company's Dupont Circle office, doesn't believe he's aiding the enemy. Conner believes that the savvier politicians become with social networking, the stronger democracy will be. "It would make no sense to cut out 50 percent of the country," he said. "It's better for us to have as many points of view. Facebook is not a partisan platform."

Yet, the company has political battles of its own to fight. Facebook recently hired Tim Sparapani, a former American Civil Liberties Union lawyer, as its public policy director. Sparapani said Facebook's challenges in Washington are convincing some federal agencies that the site is secure, and overcoming allegations that Facebook is cavalier about its users' privacy. "Our mission in this office is helping Washington understand this new phenomena of social networking and translating Washington back to Silicon Valley," he said. "Adam's been a big part of that.

Sparapani says Conner's pro bono teaching will help if and when the company needs help dealing with federal regulators. "It is better to talk to people when you don't need them than to show up when you're in trouble," Sparapani said.

One of the trickier parts of Conner's job is helping members of Congress and their staffers figure out how to use Facebook without breaking ethics rules set by the House Committee on Administration. Members of Congress and staffers, for instance, may not use a member's "campaign" Facebook page at the office, and must instead use a second Facebook page meant for official government use. To the average person, these pages are nearly indistinguishable.

Despite his affection for transparency, Conner has learned that some aspects of Washington life require discretion. Asked about White House restrictions on using Facebook, he says: "I can't go into details, but we're helping them solve some issues there."

Conner sometimes gets emergency calls. At around 9 one night earlier this month, Lt. Col. Kevin Arata, the Army's director of online and social media, discovered that someone was trying to impersonate him on Facebook with a fake account and was friending his wife and son. "I immediately got on Facebook to write Adam," Arata recalls. "He writes back within three minutes and then all the other pages were taken down."

A cautious response

But perhaps the hardest part of Conner's job is persuading cautious congressmen to reveal the oddball minutiae of their lives.

In his meeting with Roskam, Conner tries to motivate his student with the example set by actor Vin Diesel of "Fast and Furious" fame. "The most popular page on Facebook is the actor Vin Diesel," Conner says. "It used to be Obama. How did an actor become more popular than the president? The answer is that he spends a lot of time putting up personal posts. He'll put up pictures from his travels and answer questions about his movies."

Roskam, who updates his campaign and official Facebook pages along with his staffers, isn't so sure about following Conner's advice and posting items about his mundane doings. " 'I am going to the dry cleaners' -- that's not interesting," the congressman says. "I am trying to think of what is interesting from a personal connection. 'Going over to the Ways and Means Committee'? You're sensing a little caution in my voice, because you really don't want to be that guy."

What about responding to people's comments on your Facebook wall? "That is running, whereas I am more at the creeping stage," says Roskam, who as of late Tuesday had not updated his pages' walls with his own messages since early December.

As his meeting with Conner wraps up, Roskam and his chief of staff, Steven Moore, recall how Facebook helped secure younger voters in the 2008 election. "We spent $60,000 on radio ads, and about $3,000 on the Internet," Moore says. "If I had known that information going in, I would have doubled down."

"Well, feel free to spread the word to other campaign managers," Conner says.

Roskam likes what he sees in the Facebook pitchman, even though Conner is a Democrat. "There you go!" he says, extending his hand to Conner. "What a closer."

Dec 29, 2009

Rasmussen Poll - Election 2012: Nebraska Senate

{{w|Ben Nelson}}, U.S. Senator from Nebraska.

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The good news for Senator Ben Nelson is that he doesn’t have to face Nebraska voters until 2012.
If Governor Dave Heineman challenges Nelson for the Senate job, a new Rasmussen Reports telephone survey shows the Republican would get 61% of the vote while Nelson would get just 30%. Nelson was reelected to a second Senate term in 2006 with 64% of the vote.
Nelson's health care vote is clearly dragging his numbers down. Just 17% of Nebraska voters approve of the deal their senator made on Medicaid in exchange for his vote in support of the plan. Overall, 64% oppose the health care legislation, including 53% who are Strongly Opposed. In Nebraska, opposition is even stronger than it is nationally.
Fifty-six percent (56%) of voters in the state believe that passage of the legislation will hurt the quality of care, and 62% say it will raise costs.
The House and Senate have passed different versions of the health care legislation and now will try to agree on a plan to pass early in 2010. Because every Democratic vote is required to pass the legislation in the Senate, Nelson’s vote is essential. If Nelson votes to block final passage of the health care plan, he would still trail Heineman but would be in a much more competitive situation.

Official photo of Governor Dave Heineman (R-NE).

Image via Wikipedia

When survey respondents were asked how they would vote if Nelson blocks health care reform, 47% still pick Heneman while 37% would vote to keep the incumbent in office. Twenty percent (20%) of those who initially said they’d vote for Heineman say they’d switch to supporting Nelson. Another six percent (6%) of Heineman supporters say they’re not sure what they’d do if Nelson stops the health care plan from becoming law.
If Nelson votes to block health care reform, 10% of all voters would prefer a third-party option. Most of those who would prefer a third choice initially said they would vote for Nelson.
Overall, 40% of Nebraska voters have a favorable opinion of Nelson while 55% have an unfavorable view. Those figures include 12% with a Very Favorable opinion while 34% hold a Very Unfavorable view.
Twenty-six percent (26%) say Nelson has done a good or excellent job in the health care debate. Forty-seven percent (47%) give him poor marks.
Forty-two percent (42%) say their senator has been too supportive of President Obama’s agenda while 13% say he’s not been supportive enough. Thirty percent (30%) say he’s got the balance about right.
Nelson is also one of the key players in the discussion about how abortion should be handled in the health care plan. Sixty-five percent (65%) of Nebraska voters say that coverage of abortion should be prohibited in any plan that receives government subsidies. Only six percent (6%) want coverage mandated, while 22% want no requirements either way.
Obama earned 42% of the Nebraska vote in 2008, and 38% continue to approve of his job performance. Sixty-one percent (61%) of Nebraska voters disapprove of how the president is performing.

Dec 28, 2009

The not-so-sweet side of closing 'doughnut hole'

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By Amy Goldstein
Washington Post Staff Writer
Monday, December 28, 2009; A03

Six years after Congress added a prescription drug benefit to Medicare, Democrats in the House and Senate are poised to make a central change that they and most older Americans have wanted all along: getting rid of a quirk that forces millions of elderly patients with especially high expenses for medicine to pay for much of it on their own.

The closing of an unusual gap in Medicare drug coverage -- a gap that Republicans had, when they controlled Capitol Hill and the White House, insisted was needed for the government to be able to afford the program -- would "forever end this indefensible injustice for American's seniors," Senate Majority Leader Harry M. Reid (D-Nev.) said in announcing that the Senate would join the House in supporting the change.

But details of the change underscore that, for patients and the federal budget alike, the implications of the sprawling health-care bills pushed through by congressional Democrats are more nuanced than lawmakers' talking points.

The Democrats and President Obama have been clear that the "doughnut hole," as the gap is known, would disappear gradually over the next 10 years. They have not mentioned that Medicare patients would, according to House figures, face a slightly larger hole in coverage during two of the next three years than they do today.

Proponents say the government can afford to eliminate the gap because the pharmaceutical industry would pay for the phaseout. But less than half of the $80 billion that drugmakers agreed to provide, under a health-care reform agreement over the summer with Senate Democrats and the White House, would be used to help fill the gap, according to Senate Democratic aides. Moreover, there are no budget forecasts far enough into the future to show how much the expanded drug benefit would cost the government once the gap is fully closed.

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Despite such uncertainties, the prospect of filling the hole in drug coverage responds to a strong desire among older Americans -- a significant constituency that tends to be wary of changes to the health-care system. The 2003 law that added the drug benefit to Medicare was the largest expansion since the creation of the federal health insurance system for the elderly four decades ago. The new coverage became available in 2006. As of last year, about 32 million people, nearly three-fourths of everyone on Medicare, had it.

Nancy LeaMond, executive vice president for social impact at AARP, the lobby for people age 50 and over, said that although the benefits have proven popular, "you really can't have a meeting with a chapter, you can't have a town hall" without complaints surfacing about the doughnut hole. "It's a major pocketbook issue."

Pat Liberti, a retired nurse in Salem, Mass., who has heart disease and diabetes and has had five small strokes, takes 16 prescription drugs. She is 59, six years younger than the typical age to join Medicare, and is eligible because her health problems have classified her as disabled. She's entered the doughnut hole each year, this year in May. At that point, her Blue Cross/Blue Shield plan stopped paying 75 percent of her medicine's price. Since then, she has spent $2,206 on drugs.

"You know, I did everything right. I worked. I saved. I own my own home. I have an IRA," Liberti said. She had hoped to save the long-term disability checks she gets from her former job for her old age. Instead, she spends them on medicine.

How many people are in similar circumstances is unclear. The Kaiser Family Foundation, a health policy organization on whose figures House Democrats relied, estimated that, in 2007, one-quarter of the Medicare patients with drug coverage fell into the gap. Less publicized figures by the Centers for Medicare and Medicaid Services, the agency responsible for the program, show that about half that many fell into it. Kaiser and the agency disagree on how often people who reach the gap stop taking some of their medicine.

However many people have been affected, closing the doughnut hole has been a rallying cry among the elderly. During the second week in December alone, LeaMond said, AARP members placed 240,000 calls to 29 Senate offices, asking them to follow the House in eliminating the gap.

Under the health-care bill the House passed in November, people who reach the doughnut hole would be $500 better off next year than they would otherwise. But the impact over the next few years would be subtler than it appears at first for two reasons: The gap -- without any change -- is scheduled to expand each year, and the bill would fill it gradually. As a result, patients would face a larger coverage hole in 2011 and 2012 than this year, according to Ways and Means Committee data. After that, it would shrink more rapidly and disappear in 2019.

The just-passed Senate measure would narrow the gap halfway. Even before the bill was approved, Reid and the chairman of the two Senate committees that handle health-care issues said they would, as part of negotiations to resolve differences between the two bills, accept the House's goal of closing the hole completely.

Congressional budget analysts have not said how much that would cost. Instead, they predicted a savings of $43 billion over the next decade -- based on the combined effect of filling the hole and two steps the pharmaceutical industry has said it would take in part under the deal earlier this year with the White House and the Senate. As one of those steps, drug manufacturers would repay the government the difference between the prices the companies charge for medicine for low-income patients in Medicare and the prices they used to charge in Medicaid, before the drug benefit existed. As the other step, the House bill requires the manufacturers to give a 50 percent discount for brand-name drugs that patients buy once they enter the doughnut hole -- and to give the government the equivalent of that money after the hole closes.

Budget analysts say the discounts for brand-name drugs would end up costing the government money; fewer people would switch to cheaper generic medicine, in turn causing more people to reach the gap's far side, beyond which almost all remaining drug expenses are covered.

Without a Congressional Budget Office prediction, the only estimate of the cost of filling the gap comes from the Medicare program's chief actuary, Richard S. Foster, who told House Republicans it would be $31 billion over the next decade. No one has analyzed how expensive the expanded drug benefits would become after that, although health-care options prepared a year ago by the CBO provided a clue: It said that, if the gap were eliminated right away, it would cost $134 billion over 10 years.

Democrats predict that, in the end, pharmaceutical companies will provide enough money to cover the expense. Republicans are skeptical. "They are shielding the true cost by phasing it in," said Sage Eastman, spokesman for Rep. Dave Camp (Mich.), ranking Republican on the Ways and Means Committee.

Meanwhile, no one knows how much the pharmaceutical industry could end up benefiting by an expansion in coverage that could drive up spending on brand-name drugs. Said one health policy expert who favors closing the gap: "It's not very transparent."