The View From Here . . .

The endgame is upon us in the great healthcare debate. The odds favor passage of a comprehensive bill, but this is no sure thing.

To review the bidding, Democrats managed to pass their health care bill in the House on November 7 on a close 220-215 vote, with only one Republican supporting the bill. In the Senate, a somewhat different bill was passed December 24 on a 60-40 strict party line vote, the minimum number of votes needed to overcome a Republican filibuster. Now the two enacted bills must be reconciled, which is currently being done in closed door meeting among Democratic leaders and White House officials. Presumably a compromise bill will be agreed upon and submitted to both houses for final approval.

The first big obstacle is next Tuesday’s special election in Massachusetts to fill the seat of the late Senator Ted Kennedy (the seat is currently occupied by an interim Democrat.) Although Massachusetts is a very Democratic state, Republican Scott Brown, a state senator, is running a strong campaign against his opponent, state attorney general Martha Coakley. The polling is pretty inconsistent, but Ms. Coakley may have a small lead. If Mr. Brown were to pull out a victory, Democrats would have only 59 senators, one short of a filibuster proof majority. The Democrats would largely be back at square one, having to find a compromise measure that attracts Republican support.

Assuming that Ms. Coakley does manage to avoid an upset and the Democrats retain their 60-vote majority, the party will have to overcome a number of hurdles before it can enact health care legislation.

The biggest legislative issue is probably abortion. The House bill included an amendment offered by Bart Stupak, Democrat of Michigan, that basically banned any use of taxpayer dollars under the health plan for elective abortion. (Presumably Speaker Nancy Pelosi only allowed the Stupak amendment to come to a vote because she did not have enough support for the overall bill without the amendment.) The Senate bill included watered down language that is not satisfactory to prolife members in the House, nor to the Catholic bishops.

Mr. Stupak now believes he has around 10 supporters who will insist on inclusion of his amendment in the bill as a condition of their support for the legislation.. On the other hand, it is possible that a bill with the Stupak amendment would not get 60 votes in the Senate. One wonders how, for example, Kirstin Gillibrand or Barbara Boxer would vote; in a debate this week, Martha Coakley, the Massachusetts candidate, said she would oppose a bill with the Stupak amendment.

There are some other potential concerns. Labor unions are voicing strong opposition to provisions taxing benefits under so-called “Cadillac” health plans. Some liberals continue to be very upset by the lack of a “public option” provision in the Senate bill and the dismal prospects for its inclusion in the combined bill.

Then there is public opinion. Almost all polls are now showing that pluralities, if not majorities, are opposed to the proposed legislation and a new CBS poll showed President Obama with only a 36 percent rating for his handling of health care issues. While many Democrats believe that it is essential to deliver a victory to the President on this important issue, support of this bill poses significant risk for senators and representatives in marginal states or districts in the upcoming election.

In short, President Obama most likely will be signing a health care bill into law, but it is not a done deal.