House Democratic leaders had hoped to have a final vote on their version of healthcare reform legislation Saturday evening. Now it looks as if the vote could be pushed back a day or more, and for the simplest of reasons: They don't yet have the votes to pass it.
It takes 218 "ayes" to pass a bill in the House, and the Democratic caucus has 258 members. But they won't get any help from their Republican colleagues, and there's a pretty decent number of Democrats who aren't ready to vote for the bill.
The big stumbling blocks remaining are the issues of coverage for abortion and for illegal immigrants. One other potential obstacle was removed on Friday when Rep. Anthony Weiner, D-Ny.Y., agreed to drop an amendment he'd planned to offer that would have turned the bill into one that created a single-payer system. House progressives had demanded at least a vote on the amendment -- which wouldn't have passed anyway -- but they won't get it now.
House Majority Leader Steny Hoyer is preemptively blaming any delay on Republican stalling tactics, but that's a stretch, at the very least. The GOP may employ some of those tactics when the House does prepare for the vote, but the thing holding it up right now is a lack of Democratic votes.
Senate Republicans had what seemed like a pretty good idea when it comes to the fight over healthcare reform: Propose an amendment that would force all members of Congress to enroll in whatever form of public option is included in the final bill. That plan backfired, though, when their Democratic counterparts decided to actually support the amendment. So now the GOP's going further.
The latest version of the amendment is broader; beyond members of Congress, it also includes staff members, something that had been a sticking point for Democrats before. More than that, though, it would force President Obama and his cabinet into the public option.
"The White House and cabinet secretaries are working very hard for this massive overhaul of America's health care system," Grassley said in a statement reported by the Huffington Post's Ryan Grim. "It's only fair that if this bill becomes law, these individuals should themselves be subject to the reforms. The same is true for congressional staff. Quietly carving out leadership staff and committee staff behind closed doors is unacceptable. If the reforms are as good as their supporters say, the reforms should be good enough for everybody."
Casting health care overhaul as a legacy for the American people and failure as politically unthinkable, President Barack Obama on Sunday rallied Senate Democrats to deliver on their party's half-century quest to expand the social safety net by providing access for all.
At the Capitol during a rare Sunday session of the Senate, Obama delivered a closed-door pep talk to the fractious Democratic caucus that lasted about 45 minutes. Deep divisions remain over abortion coverage, but there was hope for compromise on whether the government should directly offer health insurance in competition with private companies.
"They're going to get it done," Obama said as he left. He avoided specifics in the meeting with senators and took no questions.
The health care legislation -- Obama's signature domestic policy goal -- would provide coverage to more than 30 million additional people over the next decade with a new requirement for nearly everyone to purchase insurance. There would be new marketplaces where people could shop for and compare insurance plans, and lower-income people would get subsidies to help them afford coverage.
The federal-state Medicaid program for the poor would be expanded, and there would be a ban on unpopular insurance company practices such as denying coverage based on medical history.
Senate Majority Leader Harry Reid, D-Nev., who had invited Obama, sounded confident.
Republicans "want this to be, as one senator said, President Obama's Waterloo," Reid told reporters. "And it's not going to be."
White House spokesman Bill Burton said Obama thanked lawmakers for their work and encouraged them to move ahead on "this historic opportunity." Democrats are keenly aware of former President Bill Clinton's failure to pass health care legislation in 1994, and their repudiation at the polls that November.
Obama said this is "the most significant social legislation in decades -- so don't lose it," said Sen. Joe Lieberman, I-Conn. Obama was accompanied by Vice President Joe Biden and other senior administration officials.
Obama "pledged to work with us in any meaningful way that he can," Reid told reporters.
Reid has 58 Democrats and two independents in the Democratic caucus. He may be able to get one or two Republican votes, at the most. He is still short of the 60 votes he needs to shut off debate and move to a final up-or-down vote on the bill.
At Reid's request, moderate and liberal lawmakers are trying to find a compromise on the government insurance plan that could also potentially attract Sen. Olympia Snowe, R-Maine, the one Republican to vote for the Democrats' health bill in committee.
A new idea under discussion involves national nonprofit insurance plans that would be administered by the Office of Personnel Management, which oversees the popular Federal Employees Health Benefits Program.
Snowe called the possible compromise "a positive development" because it would give consumers more options for buying insurance. Underscoring the chase for 60 votes, and the possibility that she could break ranks with the GOP, Obama met with Snowe at the White House on Saturday.
"Progress is being made and that's not just talk," Reid said. After three hours of negotiation Sunday evening, Sen. Charles Schumer, D-N.Y., said "we're not there yet," but he was encouraged.
At least one moderate Democrat was unpersuaded by Obama's appeal.
Sen. Ben Nelson, D-Neb., objects to Reid's provisions on abortion coverage, to a government insurance plan now in the bill, and to a new long-term care insurance program.
"For those who have made a decision to be supportive, I think (Obama) was persuasive," Nelson said. "There are still issues that have to be resolved."
Nelson said he expects a vote Tuesday on his amendment, which would restrict abortion coverage to cases of rape, incest or where the life of the mother is in danger. It is similar to language passed by the House last month. The Senate bill now would allow insurance plans operating in a new federally supervised health insurance marketplace to cover abortion, provided they use only funds from premiums paid by beneficiaries.
Win or lose, Nelson's amendment won't be the end of the abortion debate.
Republicans who are nearly unanimous in their opposition to the health care bill said there was plenty of raw political pressure.
"The Democrats are trying to squeeze every one of their members to swallow a very bitter pill for the American people," said GOP Leader Mitch McConnell of Kentucky.
Senators weary from months of debate said Obama made an impression.
Sen. Frank Lautenberg, D-N.J., said senators were moved to "deep reflection, and even some tears."
"He talked about how this would be a legacy, that each of us could look back to having been part of, 10 or 20 years from now," said Sen. Kent Conrad, D-N.D., a fiscal conservative.
While negotiations continued behind the scenes, the Senate rejected an amendment sponsored by Sen. Blanche Lincoln, D-Ark., to limit the tax deductions insurance companies take for what they pay their top executives. The vote was 56-42 on a measure that needed 60 votes.
Lawmakers also voted down a measure by Sen. John Ensign, R-Nev., to limit plaintiff lawyers' fees in medical malpractice cases, a politically fraught issue that pits Republicans against Democrats. That vote was 32-66.
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Associated Press Writers Charles Babington and Erica Werner contributed to this report.
At the town halls this summer, people who came to protest against healthcare reform had a few different messages and complaints. One ended up turning into a refrain: If the public option is so great, the protesters would ask their senators and representatives, then why won't Congress be using it?
Now, as the Senate's debate over its version of reform legislation kicks into gear, two Republicans -- Sens. Tom Coburn and David Vitter -- have picked up that theme and are running with it. The two authored an amendment they want attached to the bill; it would require members of Congress to enroll in whatever version of the public option the final legislation creates, if it includes one.
Both Coburn and Vitter are vehement opponents of the public option, and they're hoping to prove themselves right by showing that no senator who's in his or her right mind would want their healthcare covered by it. They've gotten a surprise, though: Genuine support for their amendment from someone on the other side of the aisle -- and a proponent of the public option, at that -- Sen. Sherrod Brown, D-Ohio.
Brown doesn't have any illusions about why Coburn and Vitter decided to introduce the amendment. "It's clear they just want to score political points. They hate the public option… they want to introduce [the amendment] and have it lose," the senator said in an interview with Salon on Friday.
But Brown's a strong supporter of the public option, and he's actually been taking a stand like this one since he was first elected to the House nearly 17 years ago, keeping a campaign promise to pay for his own coverage until Congress passed health insurance for everyone. For most of that time, he paid out of pocket; now, he's on his wife's plan, which costs him a fair amount than just using the coverage he's entitled to as a senator would. So he decided he wanted to co-sponsor Coburn and Vitter's amendment.
Senators are usually eager to collect co-sponsors for their bills and amendments, especially ones from the other party, for the simple reason that this helps the bill pass. It turns out their attitude is a bit different when the amendment in question is actually a political ploy, however. Brown's office contacted Coburn's about co-sponsorship of the amendment nine times last week, to no avail.
"We did get an email back saying they would check with their boss," Brown says, but that was the extent of the response.
So on Friday, Brown took matters into his own hands, going to the Senate floor and asking to be added as a co-sponsor to the amendment by unanimous consent. Since objecting under these circumstances is pretty much unheard of, Brown was finally added as a co-sponsor, along with fellow Democrats Chris Dodd and Barbara Mikulski.
Afterwards, Coburn spokesman John Hart claimed that his boss is "happy to have [Brown] on." He did note, however, that Brown had opposed a similar amendment when a reform bill was in the Senate Health, Education Labor and Pensions (HELP) Committee.
Asked by Salon about his earlier vote, Brown said, "The one I voted against was to include all of the congressional staff. And the public option is an option. And one of the beauties of the public option is that people have a choice. I don't want to tell the people … in my office what their families should do."
Casting its first votes on revamping the nation's health care system, the Senate rejected a Republican bid Thursday to stave off Medicare cuts and approved safeguards for coverage of mammograms and other preventive tests for women. The first round of votes ended with a fragile Democratic coalition hanging together.
Senators voted 58-42 to reject an amendment by Sen. John McCain, R-Ariz., that would have stripped more than $400 billion in Medicare cuts from the nearly $1 trillion measure. It would have sent the entire 2,074-page bill back to the Senate Finance Committee for a redo.
Republicans said the proposed cuts to health insurance plans and medical providers mean seniors in the popular Medicare Advantage program will lose benefits. And they predicted lawmakers will ultimately back away from the cuts, once seniors start feeling the brunt.
"Medicare is already in trouble. The program needs to be fixed, not raided to create another new government program," said Republican leader Mitch McConnell of Kentucky.
Democrats said seniors will not lose any guaranteed benefits. The cuts -- amounting to a 2 percent slowdown in spending -- will help keep Medicare solvent by making it more efficient, they contended. And they pointed out that the health care overhaul bill improves preventive care and prescription coverage.
"My colleagues on the Republican side have resorted to the politics of fear to preserve a broken health care system," said Sen. Tom Harkin, D-Iowa. "What we're hearing are scare tactics designed to mislead seniors."
AARP, the seniors' lobby, threw its weight behind the Democrats.
The votes Thursday came after three days of angry debate in which Democrats accused Republicans of stalling to try to kill the bill, and Republicans protested that they were only exercising their right to give the complex legislation full scrutiny.
The first votes were held under a special agreement requiring 60 votes to prevail. That tested the coalition Democrats are counting on to move President Barack Obama's signature issue. The margin was close on the women's health amendment, which aims to safeguard coverage of mammograms and preventive screening test under a revamped system.
The 61-39 vote on a provision by Democrat Barbara Mikulski of Maryland and Republican Olympia Snowe of Maine was the first substantive ballot in an acrimonious debate that promises to go on for weeks.
After that will come an amendment to restrict abortion funding, except in cases of rape, incest or to save the life of the mother. Drafted by an abortion opponent -- Democratic Sen. Ben Nelson of Nebraska -- it looms as a major challenge for the Democrats.
Though Democrats have 60 votes in the Senate, two Democratic senators voted against the Mikulski amendment -- Russ Feingold of Wisconsin and Nelson. The measure was saved by three Republicans voting in favor -- Snowe, David Vitter of Louisiana and Susan Collins of Maine.
Thursday's vote followed the heated controversy over a government advisory panel's recent recommendation that routine mammograms aren't needed for women in their 40s. Although the advisers' recommendation was nonbinding, it prompted fears that the health care legislation would usher in an era of rationing.
The Mikulski amendment gives the health and human services secretary authority to require health plans to cover additional preventive services for women. The Congressional Budget Office said the amendment would cost $940 million over a decade
Mikulski said her amendment would guarantee that decisions are left to women and their doctors, not placed in the hands of government bureaucrats or medical statisticians. She accepted a modification to her amendment by Vitter that would specifically prevent the controversial recommendations on mammograms from restricting coverage of the test.
However, Republicans said that Mikulski's amendment still left too much discretion to the HHS secretary. A competing amendment by Sen. Lisa Murkowski, R-Alaska, would prevent the government from using the recommendations of outside advisers to deny coverage of preventive services, including mammograms and Pap tests. It was defeated by on a vote of 41-59.
The Medicare vote went to the heart of seniors' concerns that cuts from the program used to finance coverage for the uninsured will undermine the quality of their care.
Furious with opposition from AARP, McCain railed on the Senate floor and delivered a message to seniors:
"Take your AARP card, cut it in half and send it back. They've betrayed you," he said.
Underscoring the political stakes, McCain, recorded "robocalls" in states that are home to key moderate Democrats asking voters to support McCain's amendment stripping the bill's Medicare cuts. The calls, paid for by the National Republican Senatorial Committee, targeted Nelson, Bennet and Blanche Lincoln of Arkansas.
"On Monday, I introduced the first Republican amendment to the massive health care bill, which would send the bill back to the Senate Finance Committee and stop the Democrats from cutting vital Medicare coverage for our seniors. I need Sen. Blanche Lincoln to join me in this effort," McCain says in the call heard by Arkansas residents.
He asks them to go to an NRSC Web site and sign a petition to Lincoln "urging her to join my effort to fight a Washington, D.C., government takeover of your health care."
The scripts in the other states were identical. Another call by a live operator was heard by voters in North Dakota, which prohibits robocalls, and it delivered the same message, targeted at Sen. Byron Dorgan.
Two Democrats voted with McCain against the Medicare cuts, Nelson of Nebraska and Jim Webb of Virginia.
A competing amendment by Sen. Michael Bennet, D-Colo., underscoring that no benefits in traditional Medicare will be cut by the legislation, was approved 100-0.
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Associated Press writers Erica Werner and David Espo contributed to this report.
Sen. Ben Nelson, D-Neb., has been a very tough nut to crack when it comes to healthcare reform, even though it's his own party's leaders trying to do the cracking. Nelson, who represents a key swing vote that Democrats must have in order to defeat a Republican filibuster, has been continuously reticent about supporting the legislation, especially because it currently contains a public option proposal.
Now, he's got a new reason to oppose the Senate's bill, and he's firm in his opposition -- in fact, Nelson says, if he doesn't get the language he wants added, he'll vote to support a filibuster.
Earlier this week, Nelson said he was working on an amendment that contains restrictions on coverage for abortion almost identical to those in the controversial Stupak amendment, which is part of the House's legislation. On Thursday, the senator told reporters that if those restrictions aren't in the bill, he won't vote for cloture.
"I've said at the end of the day if it doesn't have Stupak language on abortion in it I won't vote to move it off the floor," Nelson said.
There's a catch-22 here: Nelson probably doesn't have the votes to get his amendment attached to the Senate bill. Plus, enough House progressives have vowed to vote against the final legislation if it still contains the Stupak amendment that the bill couldn't pass. But without Nelson's vote, Senate Majority Leader Harry Reid will have to convince a Republican or two to defect in order to break a filibuster.
Has feminism been replaced by the pink-ribbon breast cancer cult? When the House of Representatives passed the Stupak amendment, which would take abortion rights away even from women who have private insurance, the female response ranged from muted to inaudible.
A few weeks later, when the United States Preventive Services Task Force recommended that regular screening mammography not start until age 50, all hell broke loose. Sheryl Crow, Whoopi Goldberg, and Olivia Newton-John raised their voices in protest; a few dozen non-boldface women picketed the Department of Health and Human Services. If you didn’t look too closely, it almost seemed as if the women’s health movement of the 1970s and 1980s had returned in full force.
Never mind that Dr. Susan Love, author of what the New York Times dubbed "the bible for women with breast cancer," endorses the new guidelines along with leading women’s health groups like Breast Cancer Action, the National Breast Cancer Coalition, and the National Women’s Health Network (NWHN). For years, these groups have been warning about the excessive use of screening mammography in the U.S., which carries its own dangers and leads to no detectible lowering of breast cancer mortality relative to less mammogram-happy nations.
Nonetheless, on CNN last week, we had the unsettling spectacle of NWHN director and noted women’s health advocate Cindy Pearson speaking out for the new guidelines, while ordinary women lined up to attribute their survival from the disease to mammography. Once upon a time, grassroots women challenged the establishment by figuratively burning their bras. Now, in some masochistic perversion of feminism, they are raising their voices to yell, "Squeeze our tits!"
When the Stupak anti-choice amendment passed, and so entered the health reform bill, no congressional representative stood up on the floor of the House to recount how access to abortion had saved her life or her family’s well-being. And where were the tea-baggers when we needed them? If anything represents the true danger of "government involvement" in healthcare, it’s a health reform bill that -- if the Senate enacts something similar -- will snatch away all but the wealthiest women’s right to choose.
It’s not just that abortion is deemed a morally trickier issue than mammography. To some extent, pink-ribbon culture has replaced feminism as a focus of female identity and solidarity. When a corporation wants to signal that it’s "woman friendly," what does it do? It stamps a pink ribbon on its widget and proclaims that some miniscule portion of the profits will go to breast cancer research. I’ve even seen a bottle of Shiraz called "Hope" with a pink ribbon on its label, but no information, alas, on how much you have to drink to achieve the promised effect. When Laura Bush traveled to Saudi Arabia in 2007, what grave issue did she take up with the locals? Not women’s rights (to drive, to go outside without a man, etc.), but "breast cancer awareness." In the post-feminist United States, issues like rape, domestic violence, and unwanted pregnancy seem to be too edgy for much public discussion, but breast cancer is all apple pie.
So welcome to the Women’s Movement 2.0: Instead of the proud female symbol -- a circle on top of a cross -- we have a droopy ribbon. Instead of embracing the full spectrum of human colors -- black, brown, red, yellow, and white -- we stick to princess pink. While we used to march in protest against sexist laws and practices, now we race or walk "for the cure." And while we once sought full "consciousness" of all that oppresses us, now we’re content to achieve "awareness," which has come to mean one thing -- dutifully baring our breasts for the annual mammogram.
Look, the issue here isn’t healthcare costs. If the current levels of screening mammography demonstrably saved lives, I would say go for it, and damn the expense. But the numbers are increasingly insistent: Routine mammographic screening of women under 50 does not reduce breast cancer mortality in that group, nor do older women necessarily need an annual mammogram. In fact, the whole dogma about "early detection" is shaky, as Susan Love reminds us: the idea has been to catch cancers early, when they’re still small, but some tiny cancers are viciously aggressive, and some large ones aren’t going anywhere.
One response to the new guidelines has been that numbers don’t matter -- only individuals do -- and if just one life is saved, that’s good enough. So OK, let me cite my own individual experience. In 2000, at the age of 59, I was diagnosed with Stage II breast cancer on the basis of one dubious mammogram followed by a really bad one, followed by a biopsy. Maybe I should be grateful that the cancer was detected in time, but the truth is, I’m not sure whether these mammograms detected the tumor or, along with many earlier ones, contributed to it: One known environmental cause of breast cancer is radiation, in amounts easily accumulated through regular mammography.
And why was I bothering with this mammogram in the first place? I had long ago made the decision not to spend my golden years undergoing cancer surveillance, but I wanted to get my Hormone Replacement Therapy (HRT) prescription renewed, and the nurse practitioner wouldn’t do that without a fresh mammogram.
As for the HRT, I was taking it because I had been convinced, by the prevailing medical propaganda, that HRT helps prevent heart disease and Alzheimer’s. In 2002, we found out that HRT is itself a risk factor for breast cancer (as well as being ineffective at warding off heart disease and Alzheimer’s), but we didn’t know that in 2000. So did I get breast cancer because of the HRT -- and possibly because of the mammograms themselves -- or did HRT lead to the detection of a cancer I would have gotten anyway?
I don’t know, but I do know that that biopsy was followed by the worst six months of my life, spent bald and barfing my way through chemotherapy. This is what’s at stake here: Not only the possibility that some women may die because their cancers go undetected, but that many others will lose months or years of their lives to debilitating and possibly unnecessary treatments.
You don’t have to be suffering from "chemobrain" (chemotherapy-induced cognitive decline) to discern evil, iatrogenic, profit-driven forces at work here. In a recent column on the new guidelines, patient-advocate Naomi Freundlich raises the possibility that "entrenched interests -- in screening, surgery, chemotherapy and other treatments associated with diagnosing more and more cancers -- are impeding scientific evidence." I am particularly suspicious of the oncologists, who saw their incomes soar starting in the late 80s when they began administering and selling chemotherapy drugs themselves in their ghastly, pink-themed, "chemotherapy suites." Mammograms recruit women into chemotherapy, and of course, the pink-ribbon cult recruits women into mammography.
What we really need is a new women’s health movement, one that’s sharp and skeptical enough to ask all the hard questions: What are the environmental (or possibly life-style) causes of the breast cancer epidemic? Why are existing treatments like chemotherapy so toxic and heavy-handed? And, if the old narrative of cancer’s progression from "early" to "late" stages no longer holds, what is the course of this disease (or diseases)? What we don’t need, no matter how pretty and pink, is a ladies’ auxiliary to the cancer-industrial complex.
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