Healthcare reform: Reaching finish line comes down to trust

Cutting deals to nail down votes is under way leading up to a House vote on healthcare reform. Trust that promises will be kept is key, but it's been eroding between House and Senate this session.

Finishing healthcare reform, in the end, will boil down to a matter of trust – both among Democrats and among the House, Senate, and White House.

Deals to nail down votes are flying thick and fast – or in many cases assumed to be, at least, since wheeling and dealing often take place behind closed doors. These are deals that do not show up in legislative language; they are gentlemen’s and -women’s agreements. Some may be merely implied.

Others appear to be explicit. Rep. Luis Gutierrez (D) of Illinois was a holdout on healthcare reform, until he met with President Obama and discussed immigration reform. Congresssman Gutierrez now supports the Senate healthcare plan that the House will vote on this weekend, even though it still would not allow illegal immigrants to purchase insurance with their own money through a new government-organized marketplace.

“After extensive discussions with the president, I believe we have a healthcare bill I can vote ‘yes’ for, and I believe we have a commitment to move forward on a comprehensive immigration reform package as soon as possible,” Representative Gutierrez said in a statement Thursday.

The whole Congressional Hispanic Caucus, in fact, is now on board with healthcare reform.

Trustworthy deals?

Rep. Bart Stupak (D) of Michigan, the lead Democratic abortion opponent in the House, says he wants to support healthcare reform, but only if the anti-abortion language can be strengthened – something that could take place in subsequent legislation. But that would involve a deal with the Senate.

“A lot of promises are made around this town,” Representative Stupak said Thursday on ABC-TV. “You got to lock them down, and there has been no lock-down yet. We’re still negotiating.”

Deals between the speaker and House members or the White House and the members, “I think most people trust those,” says Norman Ornstein, a resident scholar at the American Enterprise Institute.

If, for example, the president or his chief of staff tells a member that the president will campaign for him or her, that’s a promise one can take to the bank.

“There’s a logic to that, because that is the coin of the realm,” says Mr. Ornstein.

Wariness between House and Senate

But relations between the House and the Senate are different. So far in this session, the House has taken much more difficult votes – such as on climate change legislation – than the Senate has, leaving House Democrats feeling exposed and resentful.

“It’s clear the level of mistrust between the House and Senate, especially of the House, for the Senate, is about has high as it ever has been,” says William Galston, a senior fellow in governance studies at the Brookings Institution. “The old adage that the Senate is where bills go to die has rarely been truer than this session.”

Indeed, it has been widely reported that 51 senators have signed a letter promising to pass the so-called reconciliation package – the fixes to the Senate bill that the House is expected to pass this weekend, so that each chamber of Congress has ended up with identical legislation.

The president, meanwhile, held another campaign-style rally Thursday urging Congress to finish healthcare reform, replete with language that sought to capture the import of the moment.

“In just a few days, a century-long struggle will culminate in a historic vote,” Mr. Obama said to a cheering crowd at George Mason University in Fairfax County, Va. “We’ve had historic votes before. We had a historic vote to put Social Security in place to make sure that our elderly did not live out their golden years in poverty. We had a historic vote in civil righs to make sure that everybody was equal under the law.”