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December 21, 2009, 4:00 a.m.

Five Reasons It Might Not Pass
Obamacare still may not be inevitable.

By Rich Lowry & Robert Costa

Harry Reid got his 60. Ben Nelson resorted to the typical Washington expedient in such situations and bought into a few window-dressing compromises, in exchange for an enormous Medicaid benefit to his state. The Cornhusker Kickback joins the Louisiana Purchase as the latest evidence that there’s nothing like a hundred million or so in federal dollars to alleviate a senator’s deeply held concerns about the substance of Obamacare. Nelson’s sellout is a gigantic step toward the passage of the bill, but it’s not over yet. Here are five obstacles that still stand between Reid-Pelosi and a White House signing ceremony:

1. Public Revulsion. The bill was already under water in every major public-opinion poll, and opposed by a margin of almost 2 to 1 in the latest CNN poll. The latest NBC News/Wall Street Journal poll put its support at freezing, 32 percent. A few ticks downward and the bill will be in the 20s.

Is anything that has happened recently likely to change the trajectory? The Reid bill just got even longer, and the new version includes more tax increases. Even by the standards of the United States Congress, the process has been hide-the-children ugly: massive payoffs to the on-the-fence senators and a heedless, late-night rush to pass something, anything. The Democrats have shown no inclination to let public opinion hold them back, but the stiff headwind makes everything a little harder and reduces an already-small margin for error.

One subset of public opinion will be particularly important: Nebraska. If Nelson is perceived to have made a career-defining choice that will end his designation as a conservative Democrat and a pro-lifer, and if he takes an immediate dive in the polls, it will cast a pall over other Blue Dogs inclined to play ball. In that case, the various payoffs on offer won’t seem worth the larger cost of supporting the bill. It’s too early to tell exactly how it’s going to play in Nebraska, but Nebraska Right to Life has been appropriately excoriating about Nelson’s betrayal.

Democrats have set out to disprove Lincoln’s adage that without public sentiment nothing can succeed. They may yet succeed, but sailing into the teeth of such a howling headwind of public opinion won’t be easy.

2. The Stupak Dozen. Nelson cut a deal so far short of the Stupak language in the House that the National Right to Life Committee is going to score the cloture vote on the bill as a vote to subsidize abortion on demand. That won’t matter to anyone in the Senate, but it could have a major effect in the House. After her initial 220–215 victory, Pelosi can afford to lose only two net votes. Bart Stupak has declared the Nelson language unacceptable and vows to oppose the final bill if it doesn’t include the restrictions contained in his amendment. As John McCormack points out, earlier in the year Stupak was part of a bloc of Democrats who wrote a letter to Pelosi saying they’d stand against “any health-care-reform proposal unless it explicitly excludes abortion from the scope of any government-defined or -subsidized health-insurance plan.” Eleven of those signatories voted for the House bill.

Then there’s Joseph Cao, the Louisiana Republican who voted for the bill at the last moment during the first House vote but has said he would vote against the bill — even if doing so might cost him his seat — if it funds abortion. Surely, not all of the Stupak Dozen have that level of commitment. The full weight of the Democratic establishment will come crashing down on them if they threaten the bill. Still, it would take only two or three of them to upset the entire effort. One option would be simply to give them what they want. But will Barbara Boxer stand for the Stupak language in the Senate? This has been a devilish dilemma for the Democrats from the beginning, and it hasn’t gotten any easier as the stakes have gotten higher.

3. Who Pays? As a practical matter, it should be relatively easy to find a compromise on revenue sources. That doesn’t involve a hot-button cultural issue or a matter of deep principle like abortion. But the differences in financing between the Senate and the House bills are vast. The Senate relies on a so-called Cadillac tax on pricey insurance plans, the House on a surtax on the wealthy. The Senate long ago declared the surtax anathema, and the House is just as dismissive of the Cadillac tax. The unions hate the Cadillac tax, since they enjoy such plans themselves, the fruit of collective bargaining. If the House gives in, it will create even more unrest on the Left. If the Senate gives in, it could upset the fragile deal for 60. If this disagreement over financing doesn’t represent as dire a threat to the future of the bill as the other factors we are cataloguing, it’s still a stumbling block.

4. Feeling Blue. “Blue Dog Democrat” is understandably becoming a term of derision, denoting a willingness to object only enough to be noticed before caving in to the Democratic leadership. Yet the Blue Dogs still have to be a worry for supporters of the bill. When Obamacare first passed the House, 28 Blue Dog Democrats, more than half of their 52-member coalition, were on board. This is a pool that surely includes some very nervous votes. As Michael Barone points out, nearly 70 percent of the Blue Dogs represent districts that voted for John McCain. A vote for this bill must look even more like a potentially career-ending decision now than it did the first time around.

Keep an eye especially on the Pennsylvanians. Rep. Patrick Murphy already has four GOP opponents in his suburban Philadelphia district. After supporting round one of Obamacare, the auto bailouts, TARP, and the stimulus, Murphy may be looking for a way back toward the center. Reps. Kathy Dahlkemper and Christopher Carney, both elected in the 2006 anti-Bush sweep, represent blue-collar districts in the Keystone State in which Obama failed to reach 50 percent last year. You can bet that trio is watching the polls. Other Blue Dogs are simply getting out. In the past month, Reps. Bart Gordon (D., Tenn.), Dennis Moore (D., Kan.), and John Tanner (D., Tenn.) have all announced their retirements.

Don’t count on the Blue Dogs, though, since most of them are experts at folding under pressure.

5. The Left. Progressives are pained, at what should be their very moment of triumph. The Senate dashed their dreams of the public option. Without it, many on the left are abandoning ship. “This is the real sticking point,” said Howard Dean last Sunday. “There hasn’t been much fight from the White House on that.” It was always unlikely, no matter how much Bernie Sanders grumbled, that left-wing senators would block the deal. It’s easier to imagine a firebrand or two in the House doing it. No fewer than 60 liberals in the House imprudently made a pledge to oppose a bill without a public option. Almost all of them can be expected to eat it. But what if one or two don’t? Public-option scold Rep. Anthony Weiner (D., N.Y.) is continuing to pressure Obama to move further left. “What we’re saying is now’s your moment, big guy, you’re the Mariano Rivera of this situation,” he said to MSNBC last week. “You’re going to come in at the end, and there’s still a chance to do it.” That’s not going to happen, but perhaps a few of Weiner’s colleagues are ideologically besotted enough to lash out at the president’s “betrayal” when he doesn’t “come in” the way they hope he will.

All of this means that Democrats shouldn’t be celebrating until they have the bill on Obama’s desk. But make no mistake: The momentum for the bill that Reid had to fake a week or so ago is now real, at least within Congress. Early next year, the question may shift from whether Democrats can pass the bill, to whether Republican can make the sort of gains in 2010 and 2012 necessary to repeal it.