To pass, health reform needs House Catholic Democrats

Supporters of health reform hold signs outside a town hall meeting on health care in Miami in this Sept. 3 file photo. (CNS/Reuters)

Analysis

As the U.S. Senate moved toward a Christmas Eve vote on the Patient Protection and Affordable Care Act -- apparently with the 60 senators on board that are needed to block a Republican filibuster and pass the bill -- I was again struck by the key role that 31 Catholic Democrats in the House have played so far and are likely to play in the final outcome of the legislation.

Those are the 31 who backed language forbidding federal funding of abortion in the health care reform and then voted for the entire reform package -- in both cases as key votes for passage.

Assuming the Senate passes the bill coming before it, odds are that the House will have to accept virtually all the major compromises reached in the Senate if there is to be any chance of a final reform bill that will be adopted by both chambers and sent on to President Obama for his signature.

If the earlier House bill, passed in early November, had not included a comprehensive ban on federal funding of elective abortions, there’s little doubt that the Senate version would have no such ban. When the Senate, which is significantly more pro-choice than the House, voted on an amendment containing ban language virtually identical to that in the House version, it was soundly defeated, 54-45.

Only intensive Senate negotiations long into the night over the weekend before Christmas finally resulted in no-abortion-funding language that, along with other significant compromises, produced the 60-senator majority needed to move the bill to a vote.

A little recap of what has happened over the last six weeks or so may help to explain the importance I’ve attached to those 31 Catholic Democrats in the House who first voted for an anti-abortion-funding amendment by Rep. Bart Stupak, D-Mich., and then voted for the entire bill, which passed by the narrowest of margins.

First, Republicans -- Catholic or not -- in both the Senate and House have walked virtually in lockstep in opposition to the health care reform proposals formulated by the Democratic majority in both chambers.

Especially in the Senate, Republicans have sought to obstruct the bill by every parliamentary procedure available to them, including hours of tedious public reading of the entire bill and entire amendments.

Republicans in the House, Catholic or not, unanimously opposed the kind of comprehensive health care reform package backed by the nation’s Catholic bishops on the basis of Catholic social teaching, although they also unanimously supported prohibitions against federally funded elective abortions that the bishops called for.

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In short, Republicans in both chambers are with the church on public policy relating to abortion but against it on Catholic social teaching about affordable access to health care as a basic human right for all people.

So the decisive questions are, where are the nation’s elected Democrats on those two issues and how does their religious affiliation relate to their position?

Among House Democrats who supported the comprehensive reform backed by the bishops, a substantial majority backed strict limitations on federal funding of elective abortions that the House adopted Nov. 7 by passing an amendment, initiated by Rep. Bart Stupak, a Michigan Catholic Democrat.

Sixty-four House Democrats joined Republicans in voting for the Stupak amendment, which the U.S. Conference of Catholic Bishops strongly urged the House to adopt.

Of the 64, 36 were Catholic.

Of the other 28, 19 were part of the House’s Democratic Blue Dog Coalition -- a group of (currently) 53 moderate to conservative Democrats, formed in 1995 mainly around fiscal conservatism and a strong defense commitment, but many of whose members also share pro-life concerns.

Blue Dog Coalition members also tend to depart from fellow Democrats’ liberalism on such issues as abortion and gay marriage and, as a matter of policy, tend to encourage compromise over confrontation on various Democratic ideological issues.

The origin of the term “Blue Dogs” has several interpretations, one of which is that dogs left out to freeze in winter turn blue -- suggesting how fiscally and socially conservative Democrats feel they have been left out in the cold in recent decades by the party’s overwhelming liberal wing.

Among the 36 Catholic Democrats who voted for the Stupak amendment, 13 are also members of the Blue Dog Coalition.

Here’s where the Blue Dog and pro-life Catholic Democrat ideological relations become interesting:

• Among the 32 Blue Dog Democrats who voted for the Stupak amendment -- half the entire group of Democrats who favored Stupak– only 13 were Catholic, although Catholics made up 36 of the 64 pro-Stupak Democrats in the House. Of the other 28 pro-Stupak representatives, 19 were Blue Dog Democrats.
• Of the 64 Democrats who helped pass the Stupak amendment, the next day 20 voted against the entire bill (it passed by a narrow margin of 220-215).
• Among the 20 in that group who voted against the entire bill, 16 were Blue Dogs -- 12 non-Catholics and four Catholics.

The figures indicate that among Democratic House members who side with the Catholic Church in opposing federal funding for abortion, non-Catholics are decidedly less in favor of the kind of overall health care reform promoted by church teaching than are Catholics. The 31 Catholic House members who voted both for Stupak and for the entire package were crucial to the success of both votes.

The defection of five pro-Stupak Catholic Democrats (four of them Blue Dogs) in the vote on the final bill was nearly enough to defeat the bill; the defection of 15 non-Catholic Blue Dog Democrats who voted with Stupak but against the final bill would have won the day if only a couple of pro-life Catholic Democrats had switched on the final vote.

In other words, the combination of a pro-life/pro-health care reform coalition in the House is absolutely crucial to eventual passage of what is almost certainly a historic bill advancing Catholic social teaching on health care in the United States. However flawed that final bill may be in terms of Catholic social teaching on abortion and other health care issues, it will certainly advance that teaching, even if imperfectly on the abortion question.

Further, the Catholic pro-life Democrats in the House (in the sense that they oppose any reform that includes public funding of elective abortions) now seem to hold the key to the shape of the reform.

Will the bishops get everything they want in the Senate bill? Probably not -- but then the key question becomes whether they can sway the vote to a more strict House vote than that in the Senate on abortion -- and whatever they might achieve in the House is almost certainly doomed to defeat in the Senate.

Two footnotes:

-- A number of Catholic organizations have welcomed the no-public-abortion-funding amendments developed by Sen. Robert Casey Jr., D-Pa., that are being incorporated by Senate Majority Leader Harry Reid, D-Nev., into a manager’s amendment (due for an up-down vote following cloture to end a filibuster). Leaders of the U.S. Catholic bishops have continued to express strong reservations on the Casey-Reid language, saying it does not go far enough and radically alters the standing philosophy of the past three decades, that there should be no federal involvement in health plans that include elective abortion.

-- The Senate bill, in a bow to Connecticut’s Independent Sen. Joseph Lieberman as a key voter, has eliminated the so-called “public option,” under which the federal government would have offered federally sponsored insurance programs as an alternative to various private insurances for those unable to purchase insurance through their employer. The elimination of the public option contributes to a sharp reduction in the total number of Americans guaranteed insurance in the Senate plan, as opposed to the House bill.

One estimate is that the current House bill would leave 17 million people in the country uninsured by 2019, while the Senate version would leave 23 million uninsured. Both are significant reductions from the current 37 million or more uninsured and the projected 54 million who would be uninsured by 2019 if no reform is enacted. But the likely reductions do not begin to match the call by the church’s bishops for affordable health care access for all.

Immigration reform is an almost inevitable corollary to the health care reform bill, and the bishops have been firm supporters of a politically unpopular position that access of legal immigrants to health care, including publicly subsidized services (such as Medicaid for poor legal immigrants) ought to be an integral part of the reform. They have had some success in both the House and Senate in furthering legal immigrants’ access to health care services.

[Jerry Filteau is NCR Washington correspondent.]