Healthcare overhaul comes down to Pelosi and Obama

The fate of healthcare legislation turns on the endgame skills of two Democrats who bring vastly different assets to the task: President Obama and House Speaker Nancy Pelosi.

Obama’s signature ability to inspire fellow Democrats and Pelosi’s well-honed ability to read their parochial needs will be tested as they tackle the job of finding the last stubborn votes for the healthcare bill.

The final push is giving Obama a chance to redeem himself among Democrats who have complained that he has been too detached from the nitty-gritty of crafting the healthcare bill. In recent weeks, he has taken control of the debate, giving his party a second chance after a string of setbacks.

And Pelosi, while notably lacking in Obama’s public communications skills, has displayed her ability to corral votes in the Capitol’s inner sanctums, which will be a crucial asset.

Under the Democrats’ strategy, the House would pass the Senate’s version of the bill. Then both chambers would approve changes under the budget reconciliation process, which could pass the Senate with a simple 51-vote majority. Democrats hope to finish by the end of the month.

Obama holds a weak grip on one of the traditional tools of presidential persuasion: promising to personally campaign for nervous Democrats. His recent record has not been encouraging; Democrats have lost elections in Virginia, New Jersey and Massachusetts despite his efforts.

Pelosi (D-San Francisco) will have less latitude to lure support by slipping in special benefits for key lawmakers and their districts. That kind of horse-trading has been discredited since the outrage over a special deal for Nebraska’s Medicaid program in the Senate healthcare bill.

Not a single Republican vote is at hand -- as the Sunday talk shows underscored.

“What the American people would like us to do is not make this gargantuan mistake,” Senate Republican leader Mitch McConnell of Kentucky said on ABC’s “This Week.” “Every election this fall will be a referendum on this bill.”

Health and Human Services Secretary Kathleen Sebelius predicted it would pass, but probably without GOP support.

“I think the president would love to have Republican votes,” she said on ABC. “We’re hopeful that there will be Republican votes, but I’m not sure there will be.”

Within the Democratic majority, Obama and Pelosi face the daunting task of swaying conservatives while not losing liberals who are disappointed with concessions already made.

“A lot of people feel they have been taken for granted,” said Rep. Anthony Weiner (D-N.Y.), one of the disappointed liberals. “It doesn’t take much to start a brush fire. You’ve got a lot of dry brush and cigarette butts dropping.”

For months, as the healthcare legislation lumbered through Congress, many Democrats complained that Obama should have been more forceful and specific in his leadership. He did not open the process with a legislative proposal of his own, and declined to take an unequivocal position as Democrats split over what taxes to raise to pay for the bill and whether or not it should include a “public option” -- a government insurance program to compete with private companies.

That above-the-fray strategy began to change in January. Obama offered a comprehensive proposal in his own name and made high-profile gestures to Republicans. He endorsed the use of the reconciliation process and helped Democrats frame it not as a heavy-handed ploy but as a call for an up-or-down vote.

Last week, Obama summoned leaders of House Democratic liberal groups to the White House.

“He told us, ‘This is not the end of the road. This is the beginning,’ ” said Rep. Lynn Woolsey (D-Petaluma), who added that she would support the bill.

Republicans are trying to make the impending vote as fearsome as possible, objecting to the reconciliation process and threatening dire political consequences for Democrats who face reelection in November.

“They’re going to abuse the reconciliation rules,” Sen. Orrin G. Hatch (R-Utah) said Sunday on NBC’s “Meet the Press.” The process has “never been used for such sweeping social legislation like this.”

However, Republicans have used the process to pass major legislation, including welfare changes and President George W. Bush’s tax cuts.

Democrats are betting that voters will not punish supporters of the bill once they learn more about its benefits -- a point many look to the White House to help make.

“As president, he can carry the message about what he’s trying to do,” said Rep. Lucille Roybal-Allard (D-East Los Angeles), after meeting with Obama last week. “I wish he had been more involved earlier, but the fact he is now very much engaged is very, very positive.”

A delegation of New York Democrats gathered in Pelosi’s office near the House chamber Wednesday to tell her they were worried that the bill’s Medicaid provisions would penalize their state. Another band of Democrats complained Thursday that the bill’s Medicare provisions were too skewed to rural areas.

Liberals object that the Senate bill does not include a public option. Some conservatives object because they believe the bill allows federal funding for abortion.

Pelosi is keeping a close eye on a cadre of conservative Democrats who voted against the bill because it cost too much, but who are retiring from Congress and may be willing to support the less-costly final bill. That is why Democratic leaders welcomed a statement from Rep. Bart Gordon (D-Tenn.) indicating that he had an open mind.

“I voted against the House bill in November because it expanded coverage but did not do enough to bring down costs,” Gordon said. “I’m pleased to see the discussion moving in a more fiscally responsible direction now.”

In the marathon hunt for the final votes, Pelosi is also marshaling outside allies. She convened a meeting late last week with leaders of national hospital associations -- an industry that is an influential employer in most congressional districts, particularly in rural areas represented by many of the wavering House Democrats.

“I don’t have the votes,” the speaker told the group, according to National Assn. of Public Hospitals and Health Systems President Larry Gage, who was at the meeting. She added: “I think we can get there, but I’m going to need help from any place I can get it.”

janet.hook@latimes.com

noam.levey@latimes.com