Grit, deals, luck seal Obama's health care plan

[March 24, 2010]  WASHINGTON (AP) -- President Barack Obama and House Speaker Nancy Pelosi poured nearly all their political strength into passing a landmark health care bill that will mark Obama's legacy and shape the elections of 2010 and beyond.

Luck played a big role, too.

Three weeks after the loss of Edward M. Kennedy's Massachusetts Senate seat, Democratic lawmakers still were reeling and quarreling among themselves, unsure how to proceed against the Republicans' renewed ability to block legislation with Senate filibusters.

Then came word of a major insurance company's plan to raise premiums by 39 percent. The politically tone-deaf move by California-based Anthem Blue Cross was the perfect opportunity for Obama and his allies to remind Americans about the costs of doing nothing.

It was a "clarifying moment" in the long, fiery health care debate, recalls Nancy-Ann DeParle, a top White House adviser on the issue.

Obama had an opening. The bill, once left for dead, had new life. Another seven weeks of political warfare would pass before the president and Democratic leaders cajoled, pleaded and pushed the legislation through an angrily divided House, cutting deals to the final hours and ending with only three votes to spare. It was an improbable turnaround.

"The bill I'm signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see," Obama said at a White House ceremony Tuesday.

A team of Associated Press reporters interviewed dozens of key players to assemble this account of the health care legislation's highs, lows and near-death experiences.

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The first anniversary of Obama's presidency could hardly have been gloomier. The day before, on Jan. 19, Republican Scott Brown shocked the political world by winning the seat long held by Kennedy, a lifelong champion of health care reform. The ramifications were huge.

Democrats had been poised to inscribe their health care agenda into law by reconciling differences between a House bill passed in November and a similar measure the Senate had passed on Christmas Eve. The unified bill would need a final, anticlimactic approval in each chamber, which was virtually guaranteed.

But Brown became the 41st Republican in the 100-member Senate, restoring the GOP's power to block the health-care vote with a filibuster.

Senate leaders and some White House aides saw an obvious solution. The Democratic-controlled House could pass the Senate bill with no changes, and Obama would sign it, with no further Senate action needed.

There was just one problem. House Speaker Nancy Pelosi, D-Calif., met with her Democratic colleagues two days after Brown's win, and announced: "I don't think it's possible to pass the Senate bill in the House."

Indeed, scores of House Democrats deeply resented the Senate and its health care bill. They said it slapped too large a tax on employer-provided health plans, offered insufficient help to poor people needing insurance and contained an odious special Medicaid deal for Nebraska, whose Democratic senator had been a holdout.

Obama, asked about pressing House Democrats to swallow the disliked Senate bill, told ABC News, "I can't force them to do that."

Democrats were stuck. Sen. Chris Dodd, a Connecticut Democrat at the center of the health care effort, said he would not visit Kennedy's grave at Arlington National Cemetery for a while, as he had on Christmas Eve.

"I'm afraid he might pop out at me," Dodd said.

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On Jan. 31, Obama spoke by phone with the House and Senate Democratic leaders, spelling out a plan they eventually adopted.

The House would try to pass the Senate bill, but only in tandem with a package of "fixes" to meet its members' demands. Obama would sign the Senate bill into law. Then the so-called "sidecar" bill of fixes would go to the Senate under budget reconciliation rules, which don't allow filibusters.

Both parties have used the rules for years, but they often stir controversy. As expected, Republicans screamed foul, accusing Democrats of trying to thwart the public's will.

Obama agreed to be more assertive, putting his name on the proposal and traveling to Ohio, Missouri, Pennsylvania and Virginia to make the case to a skeptical nation.

When Anthem's proposed rate hike surfaced, it played perfectly into his narrative of a rapacious, insufficiently regulated insurance industry.

Republicans were using anger and fear of wholesale changes to health care to build opposition, said Richard Kirsch, national campaign manager for Health Care for America Now, which backed Obama's plan. "We knew the only way to fight that was to generate anger at the insurance industry," he said.

Pelosi, meanwhile, launched a member-by-member lobbying drive to round up the necessary 216 Democratic votes, with a united GOP opposing her.

She and the White House used almost every resource they had. Obama would meet with or telephone dozens of wavering House Democrats. Cabinet secretaries and even the Navy secretary called lawmakers they knew. Secretary of State Hillary Rodham Clinton made calls, as did her husband, former President Bill Clinton.

Age didn't matter. Democrats brought 11-year-old Marcelas Owens of Seattle to the Capitol to recount his mother's death after losing her health insurance. Former Notre Dame president Theodore Hesburgh, 92, telephoned Rep. Joe Donnelly, a Notre Dame alumnus who represents South Bend, Ind.

On Feb. 25, Obama convened a televised summit on health care with congressional leaders from both parties. The full day of political theater and partisan posturing was unlikely to change anyone's mind. But White House aides felt it boosted their portrayal of Republicans as obstructionists.

At this point, they said, every bit helped.

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For days and nights, Pelosi met with colleagues in her Capitol offices. A March 9 session seemed off topic, but it underscored the many cross currents of political interests that Pelosi and the White House tapped in their drive.

Democratic leaders agreed to wrap an overhaul of the federal student loan program into the health package. House liberals were glad to extricate the loan measure from a Senate logjam. And the move delighted many black and Hispanic lawmakers because it directed $2.6 billion over 10 years to historically black colleges and "minority-serving institutions."

To be sure, black and Hispanic House members might have had trouble voting against the health bill in the end. But the student loan deal helped quiet grumbling on the left, enabling Pelosi and the White House to focus on wavering Democrats in the center.

The deals included reducing a new excise tax on medical devices from 2.9 percent to 2.3 percent, while applying the tax to more items. A medical industry official said the changes were sought by Reps. Baron Hill and Brad Ellsworth of Indiana and Scott Murphy of New York. All three would vote for the health bill.

Still, some House members said they would not vote for the Senate health bill, even if they voted the same day on the sidecar of fixes.

Democratic aides floated an idea, which soon fueled new Republican denunciations. They would consider a House rule that would let members vote only on the sidecar bill and yet "deem" the Senate bill to be passed at the same time.

Critics called the "deem and pass" idea "demon pass."

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On Saturday, March 20, Pelosi still was short of 216 votes. With the showdown roll call scheduled for Sunday, two events moved her closer.

At about 1 p.m., House Majority Leader Steny Hoyer, D-Md., met with colleagues in the Longworth office building. Even rank-and-file Democrats who detested the Senate bill now felt the "deem and pass" idea had become a public-relations disaster. Hoyer said it would be dropped, drawing applause. White House officials quietly cheered.

Two hours later, Obama strode into an auditorium in the new Capitol Visitors Center, winning loud applause from House Democrats. Evoking Abraham Lincoln, the highest ideals of public service and a call for courage, Obama gave one of the most emotional -- and, some said, effective -- speeches of his career.

Rep. James Oberstar, D-Minn., called the speech touching, heartfelt and respectful, because Obama closed by saying each member must make his or her decision, based on a knowledge of their districts that only they can have.

Oberstar said he had not fully made up his mind. But the next day he would vote yes.

Protesters surrounding the Capitol personified the raw emotions. While most were content to chant "kill the bill," a few hurled racial epithets at black Democratic lawmakers, and one spat on Rep. Emanuel Cleaver, D-Mo.

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On Sunday, Pelosi and Obama feared that one last problem could deny them victory. They were unsure how many anti-abortion Democrats would side with Rep. Bart Stupak, D-Mich., who vowed to oppose the health care package unless given greater assurance that it would not allow federal funding of elective abortions.

A deal was struck by 4 p.m. Obama would sign an executive order granting Stupak's request. Aides said it merely restated the nation's long-standing policy on abortion.

The final House debate and series of procedural votes lasted well into Sunday night. Obama and his aides monitored from the White House, sneaking peeks at college basketball playoff games on TV.

When the House passed the Senate bill with three votes to spare, an ebullient president applauded in the Roosevelt Room, packed with cheering aides. He then addressed the nation by television.

"Today's vote answers the prayers of every American who has hoped deeply for something to be done about a health care system that works for insurance companies, but not for ordinary people," he said.

It was nearly midnight when Obama invited aides to the Truman Balcony for champagne. Senior adviser David Axelrod said he had never seen the president happier.

"Elections just give you the chance to do things," Axelrod recalled Obama saying. "This is the real thing."

[Associated Press; By CHARLES BABINGTON and BEN FELLER]

Associated Press writers Ricardo Alonso-Zaldivar, David Espo, Alan Fram, Jennifer Loven, Julie Pace and Erica Werner contributed to this report.

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