latimes.com/features/health/la-na-pelosi9-2009nov09,0,2168556.story
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For healthcare bill, Pelosi had to leave Left Coast behind
The House speaker built a majority one compromise at a time, yielding on
liberal touchstones including abortion.
By Faye Fiore and Richard Simon
November 9, 2009, Los Angeles Times
Reporting from Washington
In the final hours before the House approved the most sweeping healthcare
legislation in 40 years, Speaker Nancy Pelosi demonstrated that she had the one
indispensable quality required to produce a Democratic victory: a split
personality.
Pelosi is a San Francisco liberal who launched a series of
fruitless efforts to cut off funding for the Iraq war after becoming speaker
nearly three years ago. But long before making her home on the Left Coast,
Pelosi was the attentive daughter of an old-school East Coast politician who
made whatever deals it took to win. That upbringing proved crucial in the
healthcare marathon.
In the fight to get the legislation through the
House, Pelosi's impulse to tilt at windmills disappeared and her pragmatic
heritage came to the fore. That's what enabled Pelosi to build a majority, one
compromise at a time, including the pivotal deal with antiabortion
Democrats.
The math illustrated the challenge: Democrats hold 258 House
seats. But 49 of them are in districts won by Republican John McCain in last
year's presidential election. With 218 votes needed for passage, tinkering with
the bill to gain one vote could cost another.
Without the luxury of GOP
support, it became clear that the only way to hold Democratic conservatives was
to compromise on two issues close to liberals' hearts.
One was abortion.
The other was the government-run insurance plan known as the public
option.
Pelosi's readiness to compromise despite deep personal beliefs
was mirrored in her liberal colleagues, who in the end swallowed hard and chose
political pragmatism over ideological principle.
With the national
spotlight squarely on the House, Pelosi and other Democratic leaders came up
against antiabortion members of their own party, who vowed to kill the
healthcare bill unless the leadership accepted their uncompromising version of a
ban on using federal funds for abortion.
Earlier, Democrats -- who had
included what they considered a strict ban in their original proposals --
thought they could work out a modest compromise. But when that effort failed,
Pelosi gave way.
She summoned antiabortion Democrats to her ornate
Capitol office. She conferred with the U.S. Conference of Catholic Bishops to be
sure the new restrictions were acceptable. She even consulted by telephone with
a cardinal in Rome.
Then, Pelosi convened the most wrenching meeting of
all: to inform the Pro-Choice Caucus, her longtime liberal colleagues, of the
deal she had struck.
Pausing only to order in cheeseburgers all around,
she revealed that she would allow a floor vote on restrictions that many
liberals believed went beyond present law -- which applies mostly to Medicaid
recipients and to workers who receive health benefits through the federal
government.
The healthcare amendment would, in effect, ban abortion
coverage by all insurance plans purchased with taxpayer dollars -- affecting
millions more people. As in current law, the amendment includes exceptions for
rape, incest or threats to the woman's life.
Because the amendment would
draw substantial support from conservative Democrats, plus near-unanimous
support from Republicans, allowing a floor vote was tantamount to guaranteeing
that the tougher rules would be part of the final House bill.
Liberals
would have to vote for it or lose everything.
The trade-off capsulated
Pelosi's leadership style -- "kid gloves and a hidden stiletto," one member
called it.
The abortion amendment was approved. And for the whole bill --
the most sweeping healthcare legislation since the creation of Medicare in 1965
-- Pelosi got crucial votes from antiabortion Democrats.
In the weeks
preceding the landmark vote Saturday, Pelosi ruled her ideologically divided
caucus not as a San Francisco liberal but as the daughter of Thomas D'Alesandro
Jr., mayor of Baltimore from 1947 to 1959 and before that, a member of
Congress.
D'Alesandro oversaw his formidable political machine from his
home -- under the eyes of his children. (Pelosi's brother, Thomas L.J.
D'Alesandro III, later served as mayor himself.)
Pelosi, a polarizing
figure since her historic election as speaker, has dismal approval ratings
nationwide and has been a perennial target for Republicans, who scorned the
trillion-dollar healthcare overhaul effort as socialized "PelosiCare" -- at
least, when they weren't calling it "ObamaCare." But the 69-year-old speaker
assumed a role behind closed doors that seemed to come as easily as her
on-camera appearances often seemed awkward.
"She counts from the bottom,
then she counts from the top. She could lay out any bill like a deck of cards,"
said Rep. Louise M. Slaughter (D-N.Y.), an abortion rights advocate, who
applauded Pelosi's performance despite the abortion concession, which she
predicted would drive poor women "to the back alley."
The roots of
Pelosi's conundrum lie in 2006, during the political campaign in which Democrats
gained the House majority and made Pelosi speaker. The outcome hinged on
recruiting Democratic candidates who could win in red states -- that is,
conservatives. Pelosi was one of the architects of that strategy.
But it
produced a diverse Democratic majority. The healthcare bill had to appease the
party's progressive base without alienating its conservatives or costing them
their seats -- and, potentially, depriving Democrats of their
majority.
The public option too had the potential to threaten party
conservatives. Liberals insisted on it as a counterweight to insurance
companies, but conservative Democrats recoiled. As pressure against it
intensified, freshman Rep. Frank M. Kratovil Jr. was hanged in effigy outside
his Maryland office.
Eventually, the option was tweaked to make it more
palatable to moderates: Rather than paying doctors the Medicare rate plus 5%,
the secretary of Health and Human Services would negotiate rates with
providers.
Day after day, Pelosi could be seen talking in members' ears
as they gathered on the floor. Any Democrat who wanted a meeting with her got
it. In one day alone last week, she called 50 members of her
caucus.
"Apparently, she doesn't sleep or eat," Slaughter
said.
Even Pelosi, who runs on a reservoir of inexhaustible energy,
acknowledged that she was wired. "You'll have to excuse me today, because I had
a half a cup of coffee," she told colleagues at one meeting.
Looking for
the magic 218 votes, House leaders assessed the margin of error. There wasn't
any.
On Thursday, Pelosi marched two California holdouts off the House
floor and into her private office. There, Democratic Reps. Dennis Cardoza of
Atwater and Jim Costa of Fresno got a commitment to address their Central Valley
water needs.
Meanwhile, Pelosi swore in a pair of Democrats elected just
days earlier -- John Garamendi of California and Bill Owens of New York.
Two more "yeas."
Earlier, she persuaded Rep. Robert Wexler of
Florida to delay leaving Congress for a job with a Washington think tank.
Another "yes" vote.
Not all the issues were small or parochial.
To help pay for their plan, Democrats were imposing a surtax on affluent
Americans. Rep. Gerald E. Connolly, a Democrat, worried about how his prosperous
northern Virginia district would react.
When Connolly first raised the
issue, he said, senior Democrats responded, "Vote any way you want; who cares?"
He drafted a letter to Pelosi and gathered signatures from colleagues
who shared his worry.
She scaled back the tax.
She even donned
an oversize football jersey with "Mean Machine 1" on the front last month and
stood in the rain, cheering at a charity football game between members of
Congress and Capitol police. Her sights were set on Redskins quarterback turned
North Carolina congressman Heath Shuler, an undecided Democrat.
"On
something like this, she's a laser beam," said Steve Elmendorf, who served as
chief of staff under House Democratic Leader Dick Gephardt. "If she has to go to
a football game, if she has to fly somewhere, she's going to do what it takes to
win."
It's "a mixture of charm and a little bit of intimidation," said
Rep. James P. Moran (D-Va.). "And she never forgets."
No one was happy
with every particular of the final bill. But at a midnight news conference after
passage, House Democrats had what most of them thought really mattered: a
bill.
Pelosi, her red dress bright against a sea of dark suits, fairly
beamed.
"Oh, what a night," she said.
faye.fiore@latimes.com
richard.simon@latimes.com
Janet
Hook in the Washington bureau contributed to this report.
Copyright © 2009, The Los Angeles Times