Sunday, Nov. 08, 2009

Health care overhaul: House Speaker Nancy Pelosi's dealing, dedication helped get bill passed

WASHINGTON -- In the critical final hours before the House approved the most sweeping health care legislation in 40 years, Speaker Nancy Pelosi. D-Calif., demonstrated she had the one indispensable quality required to produce a Democratic victory - a split personality.

Pelosi is a deep-dyed San Francisco liberal who delighted liberal colleagues when she became speaker three years ago by launching a series of fruitless efforts to cut off funds for the Iraq War. But even before making her home on the Left Coast, Pelosi was the attentive daughter of the kind of old-school East Coast politician who made whatever deals it took to win.

In the fight to get health care 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 final deal with anti-abortion Democrats.

And 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.

Indeed, that willingness to settle for less appears now to be the dominant characteristic of her party, and of the Democratic president who put health care at the top of his agenda, Barack Obama.

At the end, with the national spotlight squarely on the House, Pelosi and other Democratic leaders came up against intransigent anti-abortion members of their own party, who vowed to kill the health care bill unless the leadership accepted their uncompromising version of the ban on using federal funds for abortion services.

Earlier, Democrats, who had included what they considered a strict ban in their original proposals, thought they could work a modest compromise. But when that effort failed, Pelosi gave way.

She summoned anti-abortion 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 she would allow a floor vote on restrictions many liberals believed went beyond present law.

Since the amendment would draw substantial support from conservative Democrats, plus near-unanimous support from Republicans, allowing a floor vote was tantamount to guaranteeing 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.

As expected, the abortion amendment was approved. And for the whole bill, the most sweeping health care legislation since the creation of Medicare in 1965, Pelosi got crucial votes from anti-abortion 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'Alessandro, Jr, mayor of Baltimore from 1947 to 1959 and earlier a member of Congress.

D'Allessandro oversaw his formidable political machine from his home - under the eyes of his children. (Pelosi's brother, Thomas L.J. D'Allesandro III, later served as mayor himself.)

Pelosi, a polarizing figure since her historic election as speaker, has had dismal approval ratings and been a target for Republicans, who scorned the trillion-dollar reform effort as socialized "Pelosi Care." 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 Slaughter of New York, a pro-choice Democrat, who applauded Pelosi's performance despite the concession she predicted would drive poor women "to the back alley."

The 2006 campaign that won back the Democratic majority and made Pelosi speaker hinged on recruiting conservative Democrats who could win in red states. Pelosi was one of the architects of the strategy, and it worked.

But it meant the health care bill had to appease the progressive base without alienating the conservatives or costing them their seats - and the Democrats their majority.

The math illustrated the challenge: Democrats have 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 the only way to hold conservatives was to make big compromises on two issues close to liberals' hearts.

One was abortion, another the government-run insurance plan known as the public option.

While liberals insisted on a public option, conservative Democrats were recoiled. And pressure against the public option intensified. Freshman Rep. Frank M. Kratovil, Jr., was hanged in effigy outside his Maryland office.

Day after day, Pelosi could be seen talking in members' ears as they gathered on the floor. Any Democrat who wanted a meeting with the Speaker got it. In a one day alone last week, she called 50 members of her caucus.

"Apparently, she doesn't sleep or eat," Slaughter remarked.

Even Pelosi acknowledged she was wired. "You'll have to excuse me today because I had a half a cup of coffee," the speaker, known to run on nervous energy, told colleagues at a morning meeting.

Looking for the magic 218, 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. The holdouts, Reps. Dennis Cardoza and Jim Costa, got a commitment to address their Central Valley water needs.

Meantime, Pelosi swore in a pair of Democrats elected just last Tuesday - John Garamendi of California and Bill Owens of New York. Two more "yeas." Earlier, she pleaded with 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 surtax on affluent Americans. Rep. Gerald 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.

Donning an oversized football jersey with Mean Machine 1 on the front, Pelosi 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.

"On something like this, she's a laser beam," said Steve Elmendorf, who served as chief of staff to former 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. Jim Moran of Virginia. "And she never forgets. "

No one was happy with every detail of the final bill. But at a midnight news conference after passage, House Democrats had what most thought mattered most - a bill.

Pelosi, her red dress bright against a sea of dark suits, fairly beamed:

"Oh what a night."

(Janet Hook contributed to this article.)