Of the Democratic senators who have set out to transform the nation's health-care system, one of the least likely is Majority Leader Harry M. Reid, whose legislative priorities typically fall more toward protecting the interests of his native Nevada.
Despite the prospect of a potentially tough 2010 reelection fight, the combative Democratic leader has assumed full ownership of a 2,074-page bill that would cost $848 billion over 10 years and institute the most far-reaching changes to the system in generations. As the Senate debate unfolds on the chamber floor, Reid has remained burrowed in his office, looking past the daily political drama playing out and, as he said recently, "getting my deals done."
When the debate over the economic stimulus program entered its final stretch earlier this year, Reid called on President Obama to act as salesman in chief for the legislation, closing every deal with high-voltage White House charm. Ten months later, as the president juggles a full slate of challenges, Reid has opted to confine health-care negotiations largely to the Senate chamber and his adjoining suite of offices, urging colleagues to negotiate compromises among themselves and to bring their concerns directly to him.
For Reid, success means emerging from the marathon debate with a bill backed by the 60 senators needed for final passage, something he hopes will come to pass as soon as late next week. Democrats' concerns will be addressed in individual amendments, but many others will be crowded into an omnibus "manager's amendment," a package Reid is expected to offer at the end of the process that will include many of the perks and fixes that members of his caucus are requesting.
As a longtime member of the Senate Appropriations Committee, where writing bills is done one favor at a time, Reid is hardly a stranger to deal-making. But he has been slow to tip his hand as he confronts uprisings from the left and right on major flashpoints, such as abortion coverage and a controversial public insurance plan.
"We're going to do our very utmost to complete health care before the end of the year," Reid, whose talents run more to vote-counting than oratory, told reporters on Thursday. The end is coming "soon," he said, whenever "we work out all the problems we have in the legislation."
As of late Thursday, the abortion issue remained the biggest point of contention. Sen. Ben Nelson (D-Neb.), who is among a handful of potential defections who could foil Reid in his quest for 60 votes, is expected to offer an amendment as soon as Friday that would ban abortion coverage in the Senate bill's scaled-back public plan. Nelson's measure would also prohibit people who receive tax credits for private health-care coverage from buying policies that include abortion services. Speaking to reporters Thursday morning, Nelson declared flatly that if his amendment fails," I won't vote to move [the bill] off the floor."
Panic
Other Democratic senators panicked as word spread of Nelson's filibuster threat. Reid shrugged off the statement. By noon Thursday, he had spoken three times to Nelson about the abortion issue and the public option. "I've always found him to be a reasonable person," Reid said. "He's trying to build coalitions on both of those, and we'll see what happens."
According to many Senate Democrats, Reid's game plan is to let Nelson's amendment to come to a vote, where it would presumably fail, allowing the leader to encourage immediate negotiations on alternative approaches. "There's always some value in seeing where people stand, then work toward a compromise," said a senior Senate Democrat involved in talks to resolve the abortion dispute.
Reid's wait-and-see approach has frustrated some liberal Democrats; they have grown impatient with the idea that the debate over a potentially historic health-care overhaul has essentially been hijacked by a handful of moderates, and fear that Reid is leaving too much to chance. But it appears to be yielding results on the public option, for months the major issue dividing moderate and progressive Democrats.
Four Democrats have announced that they would oppose the Senate bill as currently written, objecting to the inclusion of a public option. Reid had initially resisted including a government plan in the bill, but reversed himself after a revolt by his liberal colleagues, although with an opt-out clause for states that would not want to participate.
With the liberals in line, he then returned his attention to the four members of his caucus still on the outside: Nelson, Sens. Blanche Lincoln (Ark.) and Mary Landrieu (La.), and independent Sen. Joseph I. Lieberman (Conn.). Although the four backed the procedural motion to allow the Senate debate to begin, they warned Reid that they could not support the public-option language in the long term.
At Reid's urging, various senators have begun exploring alternatives for a public plan that could pass muster with the centrists, and some lawmakers are starting to examine other ways to achieve the same goals of greater competition, better coverage and lower prices. But as the negotiations unfold, liberal Democrats say they are growing increasingly realistic in their expectations.
"We'll get something, and it won't be perhaps what I like," said Tom Harkin (D-Iowa), chairman of the Senate health committee. "If those of us who are strong for the public option, if we have to give up something, then those who oppose it, they have to give up something, too. We'll meet in the middle."
Sen. Benjamin L. Cardin (D-Md.), said he has concluded that fighting for the provision, at least in its current form, is not worth risking the overall legislation. "It's going to require us to be a little more understanding," he said. "I'm trying to tone down the emotion on the public option so we can get a bill done."
The essence of Reid's calculus is to make sure that the cost of locking in one vote is not driving away another. Almost every Democratic senator has requested a favor or exemption of one form or another, senior Senate aides said.
Dangerous precedent
And Reid already has established a dangerous precedent, by dangling $300 million in Medicaid funding for Louisiana to win Landrieu's support for bringing the bill to the Senate floor. Months earlier, Reid had carved out his own Medicaid exemption for Nevada. One addition he made to the Senate bill, an increase in the Medicare payroll tax for high earners, has raised concerns with Sen. Olympia J. Snowe (Maine). Snowe, the only Republican who has been at least somewhat supportive of Democratic reform efforts, cited its potential to harm small businesses.
Two pending amendments related to Medicare drug benefits are potentially worrisome to Democratic leaders. A package of small-business incentives and protections that Lincoln and Landrieu are expected to offer could secure their votes for the legislation -- but may come with a high cost.
But given that it took four days to obtain a vote on the first amendment of dozens the Senate will consider, Democrats said more and more disputes are likely to be decided in Reid's office.
"I'd have to say the odds are, if you want to improve this package, a manager's amendment is gaining ground," said Sen. Kent Conrad (D-N.D.). "Clearly, Republicans are trying to slow-walk this thing right over the cliff."