Voting on health care: Reaching the magic number

WASHINGTON —

The unveiling of a compromise health-care proposal has Senate Democrats pondering a daunting mathematical challenge: how to keep all 59 Democrats united and attract at least one Republican to pass an overhaul measure.

As many lawmakers Wednesday got their first detailed look at a Finance Committee plan, senators began exploring whether the plan — when combined with elements of another, more liberal one — could win enough senators to reach that magic, and filibuster-proof, number of 60.

"We have to meld a couple of things together and see where we are," said Sen. Chris Dodd, D-Conn. "I wouldn't say today with absolute certainty that you could get to 60, but it would be just as foolish to say you can't get there, either."

Balancing act

In trying to reach critical mass for legislative success, advocates of a health-care overhaul face an extremely delicate balancing act. With the death of Sen. Edward Kennedy of Massachusetts, Democrats control 59 seats — including the two independents who caucus with the party — meaning they need at least one Republican to join them if they are to proceed without employing a procedural shortcut that could cause havoc in the Senate. Independent Sens. Joe Lieberman, of Connecticut, and Bernie Sanders, of Vermont, are the independents.

Senate Democrats have substantial differences of their own. More liberal members such as Sen. Jay Rockefeller, D-W.Va., and Sanders have been strong advocates of a public-insurance option; many of the more centrist Democrats have come down just as strongly against one. Centrists are interested in holding costs down; progressives want to bring more Americans under the insurance umbrella, a push that drives costs up.

Rockefeller tempered his criticism about the lack of a public option Wednesday after a private meeting with President Obama. "Nothing is clearer than the president's commitment to providing affordable and effective health care for all Americans, and he and I are united in our efforts to deliver on this promise," he said.

Changes intended to bring the centrists and conservatives in line could drive away progressives, while any move to draw in the more liberal elements could alienate the centrists. There is little margin for error.

"I continue to believe that you start at the center and then move to collect additional support on both ends of the political spectrum," said Sen. Ron Wyden, D-Ore., a health-policy expert whose seat on the Finance Committee makes him a key player as that panel considers the new plan from Sen. Max Baucus, D-Mont., who leads the committee.

Juggling the individual party demands can be dizzying. Another Finance Committee member, Florida Sen. Bill Nelson, a Democrat, is digging in against potential Medicare cuts. Pennsylvania Sen. Bob Casey, a Democrat, wants to make sure the plan does enough for poor children, while Indiana Sen. Evan Bayh, Democrat, is worried about health costs for small businesses and middle-class families.

And Democratic Sen. Ben Nelson, of Nebraska, typically one of the hardest votes for Democrats to corral, is looming as a tough sell. "At the end of the day, I want to see everything before I commit to anything," said Nelson, who added that he would have trouble backing a bill that did not have some GOP support.

Winning over only one Republican will take extraordinary effort, partly because of the intense pressure from colleagues to deny Democrats a legislative victory. Maine Sen. Olympia Snowe, the Republican viewed as the most likely to back the proposal, did not endorse the plan Wednesday, though she is talking to Democrats.

Other Republicans considered potential allies under the right circumstances have their own reservations. Sen. Susan Collins, another Maine moderate who has joined with Democrats in the past, has not seen enough emphasis on cutting health-care costs overall.

Climb toward 60

Sen. George Voinovich, R-Ohio, who is retiring and, thus, may face fewer political constraints, said he feared the expansion of coverage for the poor could bankrupt states. "To be candid," he said, "I don't know how you pay for it."

Given the steep climb toward 60, Senate Democratic leaders have begun to make another argument to lawmakers. They are pressing colleagues to vote with the party on procedural matters related to health-care legislation and against any filibuster — a 60-vote issue — even if they intend to oppose the measure in the end when simple majority rules.

Senators usually are reluctant to clear the way for a bill they might vote against, because they relinquish their most powerful leverage, but the message evidently is reaching some. "It is difficult to ask someone to facilitate the enactment of legislation with which they disagree," Bayh said. "But to move the process forward, to improve things, to get to the point where you can support it substantively, that of course I would be willing to do."

Material from The Washington Post is included in this report.