Healthcare tests Obama's grasp of Capitol Hill game

If President Obama's efforts to reform the US healthcare system were judged Olympic-style – like, say, diving or gymnastics – his score would have to factor in the highest degree of difficulty.

Not that Mr. Obama wants to think about the Olympics right now. But to get to a signing ceremony on health reform by year’s end, the president and his allies on Capitol Hill face a mighty challenge – perhaps the most difficult legislative lift since the establishment of Medicare and Medicaid in 1965.

Obama’s legislative advisers also have to hope that they’re better at counting votes than his sources were on Chicago’s chances at winning the 2016 Summer Games.

The question is, how good is Obama at playing the inside game on Capitol Hill? He was, after all, a senator for four years, though he spent much of that time running for president. More important, he has experienced Hill aides at his side, helping him navigate the various personalities and ideologies he needs to satisfy.

And that may well explain why the White House persists in avoiding a line in the sand over the so-called “public option” – the proposal for a government-run health insurance plan aimed at competing with private insurers and thus bringing down costs – and a crucial aspect of reform for liberals. In his Rose Garden remarks to doctors Monday, Obama did not mention the public option overtly, instead focusing on reforms in the private insurance industry.

Obama did, however, indirectly respond to his opponents’ critique that a public option would lead to a government-run healthcare system. The reforms, he said, “will make sure that neither some government bureaucrat or insurance company bureaucrat gets between a patient and their doctor.”

Later, at the daily White House briefing Monday, press secretary Robert Gibbs was asked if the president thinks he has 60 votes in the Senate for the public option, the number needed to halt a filibuster. His reply: that Obama is committed to legislation that provides “choice and competition,” the administration’s catch-all phrase for its overall goal that avoids endorsing any one of a number of choices, including the public option.

For now, Team Obama is working behind the scenes to keep various key senators (almost all Democrats) inside the tent, listening to their concerns and exploring bill provisions that would win their votes. Some, such as Sen. Blanche Lincoln (D) of Louisiana, are locked in tough reelection races, and wary of signing onto legislation that may not play well with their conservative-leaning voters. Others, such as Sen. John D. Rockefeller IV (D) of West Virginia, are fighting hard to add a public option to the Senate Finance Committee legislation, or least make sure the public option ends up in the final version of reform.

In the complicated dance of healthcare reform, the White House has to do two things at once, says Cal Jillson, a political scientist at Southern Methodist University in Dallas.

“There’s the small ball of trying to hold Blanche Lincoln and not lose [Oregon Democratic Sen. Ron] Wyden or Rockefeller, and maybe pull over Olympia Snowe,” Mr. Jillson says, referring to the Maine senator widely seen as the only Republican who may vote for the reform plan.

“Then there’s the strategic question over the next six weeks of how they play through the House and Senate to get to the conference committee, and craft a bill that can then pass both houses to go to the president’s desk,” he adds.

Monday was supposed to see the release of the Congressional Budget Office’s (CBO) cost analysis of the Senate Finance Committee’s healthcare bill. But that is now not expected until later this week, and the committee will not vote until it has the CBO number. Senator Snowe has insisted on seeing that number before deciding her vote. That could delay next week’s expected floor debate in the full Senate.

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