Ruth Marcus has a good rundown of the mathematical hurdles facing the White House as they try to pass their health care bill:

In the House, the only way to cobble together a majority will be to secure votes from moderate Democrats who balked at passing the bill the first time around. These are the lawmakers who are most rattled by the Massachusetts vote — with good reason. For a Democratic House member in a swing district, the politics counsel against voting yes. “This is a career-ending vote,” one Democrat told me — and this was a lawmaker who voted for the original bill.

With the House down a few members, 217 votes will be needed for passage. The original House measure passed with 220 votes — with 39 Democrats defecting. But two of those yes votes are gone: John Murtha of Pennsylvania died; Robert Wexler of Florida resigned. A third, Neil Abercrombie of Hawaii, is leaving at the end of the month to run for governor. The lone Republican voting for the measure, Joseph Cao of Louisiana, is no longer on board.

Meanwhile, the president’s proposal does not include the anti-abortion language inserted in the House-passed measure by Rep. Bart Stupak (D-Mich.), largely because the Senate would have difficulty fiddling with abortion language under the restrictive rules of the reconciliation process. So Stupak will be gone, and with him another five votes, perhaps more.

There are a few liberal lawmakers who might be wooed back — Ohio’s Dennis Kucinich, for instance, voted against the first version — but not enough to make up the difference. So the fate of the measure rests with the conservative Democratic Blue Dogs. A few are retiring — including John Tanner and Bart Gordon of Tennessee — and might be persuaded to switch their votes. This would help, but probably not enough.

I’ve always thought that the votes Stupak brought with him were much less than he claimed, more likely in the 3-5 range. But he may hold more than that going in to a final vote as members from conservative districts look for an excuse to vote against the bill.

Marcus says that the President’s bill is more “moderate” than the House bill. I think forcing Americans to pay 8% of their income to private companies is actually a really extreme thing to do, but even putting that argument aside, the President’s bill is indisputably more unpopular than the House bill.

People would rather have wealthy people foot the bill than have their existing insurance coverage weakened

Nancy Pelosi brags that “80 percent of the excise tax on high-cost insurance plans” has been eliminated, but as Dave Dayen explains, it’s wasn’t:

[The excise] tax initially came into play in 2014; now it gets delayed to 2018 for all plans, not just union plans. The tax at 2018 was designed to rise annually by the CPI + 1%. That would mean that the 2018 level of the excise tax was always going to be around $27,500, which is the new threshold they’re calling an “increase.” It’s a bit of a “fun with math” game.

So let’s look at how brutally unpopular the excise tax of the President’s plan is as a way to pay for health care reform, vs. the tax on the wealthy included in the House bill. According to polling done by Lake Research/Anzalone Partners in Sept. 2009 (PDF):

President’s Bill

National House Swing Maine

House Bill

National House Swing Maine
Favor Oppose Favor Oppose Favor Oppose Tax on wealthy
Favor Oppose Favor Oppose Favor Oppose
Placing a tax on the
highest-cost private
insurance policies in
order to pay for health
care reform”
41% 54% 29% 55% 40% 50% “Raising taxes on
households making
more than three
hundred fifty
thousand dollars
a year in order to pay
for health care reform”
60% 40% 53% 43% 57% 38%

The polling finds that the House surcharge is significantly more popular in swing districts than the Cadillac tax. The Anzalone pollsters also found that “voters are less likely to re-elect their member of Congress or President Obama by margins of 41 points (63% less likely to 22% more likely) and 38 points (61% to 23%), respectively, if they support an excise tax.”

The polling also determines that independent voters flee over the issue: “Across each region, opposition to taxing high-cost insurance plans is even higher among Independents, with 74% of these voters overall opposed to such a tax.”

A couple of anomalous polls maybe? Well, maybe not:

Cadillac vs. Wealth Tax


Oct. 15-18, 2009

USA Today/Gallup

Oct. 16-19, 2009


Jan. 18-19, 2010
Favor Oppose Favor Oppose Favor Oppose Favor Oppose
Cadillac Tax (President’s plan) 35% 61% 38% 59% 38% 59% 33% 63%
Tax on wealthy (House)
61% 34% 61% 34% 64% 35%

And then there’s the mandate

They also asked voters which they preferred: an individual mandate to buy insurance from a private company, or the the individual mandate with the choice of a public option. Here’s what they found:

President’s Bill

National House Swing Maine

House Bill

National House Swing Maine
Individual mandate
Favor Oppose Favor Oppose Favor Oppose Mandate + PO Favor Oppose Favor Oppose Favor Oppose
“Requiring everyone
to buy and be
covered by a private
health insurance plan”
34% 64% 34% 60% 35% 55% “Requiring everyone to
buy and be covered by
a health insurance plan
with a choice between
a public option and
private insurance plans”
60% 37% 50% 46% 55% 40%

It appears that in these key swing districts, voters just don’t like being forced to pay money to private insurance companies. And I actually don’t think this is an adequate snapshot of what people really feel about the individual mandate, because when we polled swing districts we found that what people really objected to was not the mandate but the fine of up to 2% of their annual income for non-compliance. Our numbers had an even bigger swing for Arkansas-02, Ohio 01, New York 01 and Indiana 09.

The President’s plan now increases that fine to a maximum of 2.5% of annual income.

As I wrote in January, Obama and most Senate incumbents don’t really have to worry about the electoral consequences of getting a “win” and passing the Senate bill. The Senate’s “pride of authorship” and desire to pay off their big donors has rendered them recalcitrant even now that the “60 vote” myth has been blown up.

As Marcus notes, however, Democratic House members see their own political futures coming to an end in 2010, in a “we are all Martha Coakley” moment that no amount of spin will take away. Districts like AR-02 and OH-01 were listed as “tossup” races, but polling by SurveyUSA showed the incumbents down 17 points against their Republican opponents. Even as the DCCC was furiously trying to deny the validity of our polls, Stu Rothenberg shifted 28 races toward the GOP in the wake of the Massachusetts election.

Meanwhile, the one House Democrat who has performed surprisingly well in a Republican leaning district — Larry Kissell — notably did not vote for the House health care bill. When PPP polled the district in January, they found Kissell leads all his GOP opponents by 14 points.

Does anyone think it’s more likely that wavering Democrats will switch their vote for a health care bill which now includes components that are even more unpopular?

Rick Klein has a rundown of various responses to the President’s health care bill. Those who predict House Democrats will fall in line and switch their votes believe they will do so in order to give Obama a “win.” In order to do that, however, these Democrats will have to be convinced that the President’s bill is more popular than the House bill they voted against, and it’s not going to cost them their seats.

I think Ruth Marcus has the math — and the conventional wisdom among Democratic House members — about right. Color me skeptical.