If House Progressives Reject The Senate Health Care Bill, Where Will Pelosi Turn?

In November, House Speaker Nancy Pelosi passed a health care bill by almost the slimmest of margins. The final vote was 220-215. One Republican--Rep. Joseph Cao (R-LA)--voted with 219 Democrats to pass the bill.

Pelosi probably could have forced a wider victory, but freed up vulnerable members to vote against the bill for political reasons. Next year, though, her caucus will be faced with a fairly different, less progressive bill--something modeled on the Senate's health care package--and she'll likely have to draw on a marginally different coalition of members.

On the left, Pelosi could lose some progressives, miffed about the demise of the public option, and unhappy with the abortion language in both bills. On that score, she could lose a number of resolutely pro-choice Democrats. Cautioning that the abortion language in the conference report hasn't been finalized yet, and that nobody's committed to vote one way or another, one keyed in aide said members like Reps. Diana DeGette (D-CO), Jane Harman (D-CA), Rosa DeLauro (D-CT), Louise Slaughter (D-NY), and Jan Schakowsky (D-IL) have grave concerns about both the House and Senate bills' abortion provisions.

Of course, with 218 members needed to pass a bill, and 219 Democrats voting 'aye' the first time around, Pelosi faces a nearly zero-sum game. If she encounters defections from her progressive wing, she'll have to make up those votes among conservative-voting freshmen, sophomore, and Blue Dog members, who opposed the House bill the first time around.

One place she could start is with three retiring Democrats who voted no in November, but now have little to lose politically by switching their votes.

Blue Dog Reps. Bart Gordon (D-TX), and John Tanner (D-TN) both voted against the bill this fall, then quickly announced that they won't be seeking re-election in 2010. Along somewhat different lines, Pelosi also lost a fairly progressive vote from Rep. Brian Baird (D-WA)--a psychologist, who held out because he was concerned about the impact health care reform would have on consumer's insurance premiums. That analysis is now in (it's mostly good news), and Baird is also retiring, so he's an obvious contender.

Remember, though, that 39 Democrats voted against the House health care bill, and 37 of those were moderates. We'll have more on that bunch later. They comprise a fairly large field of Democrats to pluck from if Pelosi faces defections from the left.

This will be a key dynamic to follow in the weeks ahead.