The 60th vote?
The health-care bill, according to Senate sources, is at 59 votes. Joe Lieberman, for better or worse, seems placated. The question is who will be number 60.
No one thinks Susan Collins will even entertain the notion. Olympia Snowe also seems unlikely. Both might sign onto a bill that will pass without them -- "if you can get 60, you can get 62," as some in the Senate say -- but neither is expected to provide the crucial vote to break a filibuster.
Enter Ben Nelson. Nelson, recently, has been persistently constructive. His Stupak-like abortion language was defeated, and though that didn't end his efforts on the issue, it didn't unleash a torrent of filibuster threats. He was a member of the Team of Ten that concocted the Medicare buy-in compromise. He's been waiting for CBO scores and offering amendments and attending meetings with leadership.
But his proposals are getting, well, weirder. His latest idea is to let states opt out of the plan altogether. The reason? The Medicaid expansion, he says, is an "underfunded mandate."
As my colleague Alec MacGillis explains, this doesn't make much sense. The federal government picks up 93 percent of the new Medicaid costs in the bill. The losers here are states that have generous Medicaid programs, like Maine or Massachusetts. They'll still be paying up to 50 percent of those costs, because they're paying them now, and the bill doesn't alter those current arrangements. Nebraska, by contrast, is getting a sweet deal.
Meanwhile, if states can, as Nelson suggests, find cheaper ways to cover low-income residents than Medicaid, they can already opt out using the innovation waivers built into the bill. But they can't. It costs about 30 percent more to cover someone through private insurance rather than on Medicaid. One of the ways the House bill saved money was by moving more people onto Medicaid, as it was less costly than giving them subsidies for private insurance.
And while a case could be made that removing Medicare buy-in, and even the public option, wasn't harming the basic structure of the bill, it's hard to say the same for a process in which states would simply opt out of the whole thing, with no need to achieve the objectives in other ways.
As Steve Pizer and Austin Frakt note, this is part of what made Lieberman's maneuvering so frustrating. Unlike Nelson, Lieberman is from a fairly liberal state. Keeping Nelson's vote, just as a matter of political theory, is going to be harder than keeping Lieberman's. But since Lieberman insisted on killing the public option himself, now Nelson has to take his own stand. It almost makes one yearn for the days of stimulus, when the conservative Democrats and moderate Republican cohered into a single voting bloc, and so got the compromising done all at once.
Photo credit: By Karen Cooper/Face the Nation via Associated Press