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By Jay Cost

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Is Health Care Reform A Sure Thing?

David Dayen over at FireDogLake has a clip of Emanuel Cleaver giving a less-than-bullish account of the prospects of health care reform in the House:

As Dayen notes, the math is not a slam dunk for House leadership.

Consider the following.

The bill earned 220 votes the first time around. Yet Robert Wexler has resigned. That puts the total support at 219.

Let's assume that the new bill will lack Stupak language on abortion - a reasonable one, I think. That would lose them Joseph Cao, the sole Republican supporter. Bart Stupak claims that he has 10 to 12 Democrats who would walk away then, too.

Assuming Stupak's number is correct, that puts the bill at 206 to 208, with 218 needed for support. The House leadership would have to find 10 to 12 supporters among the 38 Democrats who voted against it late last year.

TalkingPointsMemo has been keeping careful track of these members, and they have found four who are still nays, seven who are "keeping their options open" (TPM's phrase), and just one "leaning yes." The one leaning yes is Jason Altmire, who appears to have attracted a serious Republican opponent for his western Pennsylvania district. He also voted against the rule for debate and amendment on the original bill. He also didn't vote for it when it was in Education and Labor. These are the sort of things a member does when he's looking to build a track record of opposition. So color me skeptical that he's actually leaning yes.

If TPM's count is correct, and my math is not terribly off the mark, it suggests that Pelosi and the Democratic leadership would have to attract 10 to 12 of the nay votes. Here's the list of those whose votes are still conceivably gettable, from TPM. "BD" indicates a Blue Dog, "F" indicates a freshman:

John Adler (D-NJ): F
Jason Altmire (D-PA): BD
Brian Baird (D-WA)
John Barrow (D-GA): BD
Dan Boren (D-OK): BD
Rick Boucher (D-VA)
Allen Boyd (D-FL): BD
Ben Chandler (D-KY): BD
Travis Childers (D-MS), BD
Artur Davis (D-AL)
Lincoln Davis (D-TN): BD
Chet Edwards (D-TX)
Bart Gordon (D-TN): BD
Stephanie Herseth Sandlin (D-SD): BD
Tim Holden (D-PA): BD
Larry Kissell (D-NC): F
Dennis Kucinich (D-OH)
Suzanne Kosmas (D-FL): F
Frank Kratovil Jr. (D-MD): F, BD
Betsy Markey (D-CO): F, BD
Jim Marshall (D-GA): BD
Jim Matheson (D-UT): BD
Charlie Melancon (D-LA): BD
Michael McMahon (D-NY): F
Walt Minnick (D-ID): F, BD
Scott Murphy (D-NY): F
Glenn Nye (D-VA): F, BD
Colin Peterson (D-MN): BD
Mike Ross (D-AR): BD
Heath Shuler (D-NC): BD
Ike Skelton (D-MO)
John Tanner (D-TN): BD
Gene Taylor (D-MS): BD
Harry Teague (D-NM): F

Scanning this list, it's easy to tick off a bunch of people who are going to be all but impossible to win over: Boren, Artur Davis, Edwards, Kratovil, Kucinich, Melancon, Minnick, Shuler, Taylor come instantly to mind. I'd put some more on that list. Eliminating the Stupak language is not going to help them when one looks at the places where most of these people come from. 19 of these members are from the South. And if we cross-reference this list with CQ's ">chart of "McCain Democrats," we find that 25 of them hail from districts that voted for John McCain for President, some by very large margins. That's important because, for as unpopular as health care reform is nationwide, we should expect it to be less so in these districts. On this point, it's worth noting that a recent Public Policy Polling survey of Larry Kissell's North Carolina district produced some cross-tabs that suggest a yea on health care reform is harmful. Voters who (correctly) believed he voted against the bill in November were more likely to support him than those who (incorrectly) believed he voted against it.

Also, we're assuming that Kucinich is the only one who votes nay because the bill is not liberal enough. So far, I haven't heard a credible threat of defection from another progressive member, though Dayen suggests it's a possibility.

There are many factors that should help Obama and Pelosi pick up some of these nays. Eliminating the public option might make it easier for many of these moderates to vote yea. Stupak might not actually have 10 to 12 votes. Pelosi might have had some votes in her pocket should push come to shove (although probably less than the number who are really committed to Stupak language - otherwise she would not have acceded to his demands in November). Three of these members (Baird, Gordon, and Tanner) have announced retirement plans, so they might be disposed to vote with the party now that electoral pressure is gone. Others might be planning to retire but have not yet announced it, giving her more possible votes. Above all, the political pressure on these members to support the bill will be tremendous - and even if they are actually hurting their electoral prospects by voting for the bill, you can bet the White House and the House leadership will make a very strong argument that this will help them. See, for instance, Ben Nelson's pre-Christmas negotiations.

Still, I think it is far to hasty to say that this reform is inevitable. Minimally, the margin in the House is going to be razor-thin either way. We know that for sure, which in turn suggests that we shouldn't take final passage for granted. Emanuel Cleaver apparently isn't.

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-Jay Cost