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National Journal: Pelosi's Bill: How She Did It

By Richard E. Cohen

''Sam Rayburn could have walked down the streets of Spokane without anybody noticing him,' former Speaker Tom Foley, D-Wash., once said of another speaker, who held the position for 17 years and worked the Capitol's back rooms as probably the most powerful House leader of the 20th century. Those times have changed, but only in part.

As House Democrats moved toward approval of their landmark health care reform plan on the night of November 7, Speaker Nancy Pelosi, D-Calif., was unmistakable as she worked the floor. Wearing her trademark confident smile and a striking red dress, the first woman speaker exuded a commanding presence that the portly, bald Rayburn and her other predecessors could barely have imagined. She was the center of attention, surrounded by colleagues and aides. The disdainful GOP complaint that 'It's Nancy world' and that almost everything in the House revolves around her may never have been more fitting.

Pelosi's management of the health care reform effort nonetheless revealed that she has much in common with Rayburn's vaunted leadership style. She showed steely determination in scoring an achievement unlike that of any lawmaker before her, moving sweeping health insurance reforms closer to enactment than at any time in the nation's history. And in the process, she centralized perhaps unprecedented control in the speaker's office.

House Minority Leader John Boehner, R-Ohio, is fond of describing the health care legislation that the chamber approved 220-215 as 'Pelosi's bill,' GOP shorthand meant to belittle liberal excesses. 'Speaker Pelosi's bill will lead to higher health insurance premiums and impose new burdens on taxpayers from all walks of life and the nation as a whole,' Boehner wrote in a November 4 op-ed in The Miami Herald.

In many respects, this was, in fact, Pelosi's bill. After failing to deliver on her prediction and hope that the House would pass the measure before the August recess, she and her staff worked persistently throughout September and October to craft many of the legislation's crucial details to sway undecided or dubious members. Although the 1,990-page bill was formally filed on October 29 by Rep. John Dingell, D-Mich., the dean of the House, and was co-sponsored by the chairmen of the three committees that approved versions in July, it was Pelosi's handiwork.

She was the player most responsible for guiding the complex measure to passage -- not President Obama or White House Chief of Staff Rahm Emanuel, and not the committee chairmen. She engaged in constant deal-making, in several dozen caucus meetings and perhaps thousands of phone calls and hallway conversations with Democratic members. Whether out of courtesy or desperation, she revisited some members who had made their opposition to the bill clear. 'She is talking to everyone who is not a 'yes,' even if they have been 'no,' ' a senior Pelosi aide said two days before the vote.

At the 11th hour, the speaker made some cold and calculated decisions to ensure that her splintered ranks would produce the required 218 votes. She turned her back on the 'robust' version of the government-run public insurance option that she and other liberals preferred. And she infuriated abortion-rights supporters by accepting restrictions on abortion coverage that moderate holdouts demanded.

In the wake of the vote, some Democratic colleagues brushed aside the term 'Pelosi's bill,' saying that crafting it was a caucus-wide effort, but they did not dispute the speaker's impact. 'She is the best vote-getter that I have ever met,' said Rep. Anna Eshoo, D-Calif., one of Pelosi's closest allies. 'She is like a nuclear submarine.' Eshoo added, though, 'This is not her personal bill. She leads and builds consensus with enormous attention to detail.'

'She is going into the legislative hall of fame,' said Rep. Robert Andrews, D-N.J., chairman of the Education and Labor Subcommittee on Health, Employment, Labor, and Pensions. 'The speaker used the force of her authority to lead a roughly six-week amendment process until the design was frozen. I can't remember a time when members had so much opportunity to contribute to a bill.... She imposes not her will but the will of the majority. If she imposed her will, the bill wouldn't have passed.'

For now, Pelosi has enhanced her power and luster in the eyes of many Democrats. At a time when other key House and Senate Democrats have held back or have been hamstrung by their own problems, she stepped forward to break deadlocks, leading the way to a narrow victory that often seemed elusive. 'Very little that the speaker does is ad hoc,' Rep. Debbie Wasserman Schultz, D-Fla., said. 'She is methodical, thorough, and detail-oriented. It was a masterful decision on her part for members to feel that they have an impact on the bill.'

Pelosi's skillful legislative maneuvering could eventually carry a price with various groups on the Hill and ultimately the American people. Republicans, who demonstrated near-unanimous opposition to the House bill, now have a personal target to go after. In her own party, the speaker created some ill will among the liberal base by abandoning long-standing priorities when they appeared to lack majority support in the House. And some moderates, who fear that the leadership was willing to sacrifice their seats for a legislative victory, still object to the bill's sweep.

At an emotional and joyous press conference shortly after the House approved the bill around 11:15 p.m. on Saturday, Rep. Chris Van Hollen, D-Md., the assistant to the speaker, acknowledged the many divisions within his party. 'We are a big family. Sometimes we have differences,' he said. 'But we work them out, unlike the Republicans, who purge anyone who does not keep with their ideology.'

Republicans, for their part, contend that Pelosi is on dangerous ground -- in leading her party and in preparing to face the electorate next November. Noting the low public-approval scores for Congress and for Pelosi, Rep. John Shadegg, R-Ariz., recalled his experience as a House freshman in 1995 under then-Speaker Newt Gingrich, R-Ga. 'Newt got busted because he ran the House from the top down,' Shadegg said. 'Pelosi better look out. She has control based on fear. Democrats are sick of being pressured by her.'

Deal-Cutter

Despite being a heavy lift, health care reform was not Pelosi's most personal battle this year. She has said that last spring's House approval of Iraq war funding was the hardest vote for her because of her own reservations, and those of many other Democrats, about the conflict. Passage in June of the cap-and-trade energy bill got Pelosi a win on what she has termed her 'signature' issue, one that could have long-term world-wide consequences. And the most politically important issue for the Democrats may be their handling of the economy, including the huge stimulus bill that the House passed the week after Obama's inauguration.

But health care reform surely posed the greatest test for the speaker. It is complex legislation that has widely varying effects across House districts. Although Pelosi gained some familiarity with the issues during the House's unsuccessful efforts to expand the State Children's Health Insurance Program under President George W. Bush, her previous two decades in the chamber left her with little experience on the broad topic.

'This may not have been her niche earlier,' Andrews said. 'But, as speaker, she became an expert on health reform because the president and the country needed her.'

In her general views on health care, Pelosi fits comfortably in the party's liberal camp. She supports a 'single-payer' system that would be financed by tax increases, but that approach was a nonstarter in this debate, not least because of Obama's opposition. So for much of the year, Pelosi repeatedly voiced strong support for a 'robust' version of the public health insurance option.

Finally, in late October, she and other party leaders reluctantly pulled the plug on that effort, after whip counts showed that it could not secure a House majority. Liberals and moderates had wrangled for weeks over the structure of the public option. The settled-upon compromise would allow the government to negotiate payment rates with health care providers, as fiscally conservative Democrats in the 'Blue Dog' Coalition preferred, rather than basing reimbursements on Medicare rates, as liberals had wanted.

Even some of the liberals who lost that battle credit Pelosi for trying her best. 'A leader has the responsibility to move a bill forward. That requires compromise,' said Rep. Jim McDermott, D-Wash., a chief proponent of the single-payer approach. Asked about Pelosi's intraparty critics, he laughed and said, 'It's messy when you pass a big bill like this.'

On the abortion issue that dominated the final days before the House vote, Pelosi also put aside her long-standing personal views in search of an uncomfortable compromise. A faction of abortion foes, led by Rep. Bart Stupak, D-Mich., and backed by the U.S. Conference of Catholic Bishops, forced Democratic leaders to accept an amendment that would ban the public plan from covering abortion and prohibit insurance companies from offering abortion coverage to people who receive government subsidies to help them buy insurance. Sixty-four anti-abortion Democrats joined with Republicans to pass the amendment, 240-194.

Despite the speaker's retreats from such progressive positions, most House liberals stuck with her and ultimately voted for the bill -- including all 21 Latino Democrats; all but one of the 39 African-Americans (Rep. Artur Davis, who is running for governor of Alabama, voted no); and all but three of the 56 Democratic women (first-term Reps. Suzanne Kosmas, D-Fla., and Betsy Markey, D-Colo., and Rep. Stephanie Herseth Sandlin, D-S.D., were opposed).

That left Pelosi to negotiate chiefly with wavering white male Democrats, particularly rural centrists. Rep. Dennis Cardoza of Pelosi's home state of California complained that the House sponsors were slow to respond to the concerns of his low-income Central Valley district, which has high rates of uninsured and unemployed people, and has suffered large numbers of home foreclosures. 'The unwillingness to focus on what is important in a member's district with serious crises affects our malleability,' Cardoza said three days before the vote.

He was one of the last Democrats to announce he would back the bill, issuing a November 7 statement that he had secured support from House leaders and the Obama administration for an added $500 million for medical schools in rural areas, including the University of California's Merced campus in his district. The funding, he said, will result in 'more doctors in our region that will help residents of the Valley lead the healthy lives that they deserve.'

Pelosi had several last-minute exchanges -- including a 30-minute phone call -- with Rep. Rick Boucher, D-Va., who had voted against the bill in July on the Energy and Commerce Committee. Like some other undecided members, Boucher was worried about financing for rural hospitals in his district. 'My views are well understood by the speaker and majority leader,' he said in an interview a day before the vote. 'I have not detected a willingness by the leadership to amend [their bill] to address my concern.'

Boucher ended up voting against the measure, but he praised Pelosi's handling of the effort. 'I have never seen a speaker so involved in the details of legislation and taking the time to understand the views of members,' he said.

The Caucus As Committee

Several House Democrats said that the Pelosi's two-month marathon of negotiations on the health care bill this fall was similar to what they do in committee.

'The Democratic Caucus has been operating as the committee of jurisdiction,' said Rep. Jared Polis, D-Colo., who had objected to the proposed new taxes on the wealthy to pay for health care reform. Polis and other freshmen won Pelosi's approval for less onerous tax rates and then worked with her staff and aides on the Ways and Means Committee to craft the compromise. 'This was the only way to get a buy-in from the caucus' for the tax provisions, he said.

Rep. Gerry Connolly, D-Va., the freshman class president, praised Pelosi's cooperation on a host of other issues as well. 'She is a very skilled inside player,' he said. 'She possesses the entire panoply of insider skills. She knows when to cajole, exhort, step back, when to make an implied threat, and when to listen.'

Connolly said he appreciated Pelosi's support of the freshmen on the tax issue and her handling of the Ways and Means Committee. 'She saw what we were getting at and understood the legitimacy,' he said. 'To her credit, she didn't patronize us, and she supported us at the caucus meetings. I saw the unhappiness by some tax writers that she was pressuring the process.'

Although Ways and Means Committee Chairman Charles Rangel, D-N.Y., endorsed changes to the bill that his committee had approved in July, not everybody was satisfied. 'Observing the regular order with committees would have been much better,' said McDermott, a senior Ways and Means member. He placed some blame on Republicans for the weakening of committees under Gingrich.

The Energy and Commerce Committee also came away with its share of bruised egos. Rep. Peter Welch, D-Vt., a panel member, praised Pelosi for 'the political and emotional energy to reach out to every wing of the caucus.' But he worried about 'the significant concentration of power with the speaker' and emphasized the benefit that committees can offer with 'a strong buy-in for members.'

During the spring, Pelosi had designated Majority Leader Steny Hoyer, D-Md., to work with the six committee and subcommittee chairmen of jurisdiction to prepare a unified health care reform framework for committee action. Aside from Rangel, two of those committee chairmen are Californians who have been close to Pelosi: George Miller at Education and Labor, and Henry Waxman at Energy and Commerce.

In July, however, the Energy and Commerce panel's health care markup bogged down amid intense negotiations between Waxman and balky Blue Dogs. Although the panel finally passed the bill on July 31, it was clear that the House was not ready to act. Angry protests at town hall meetings resonated across the country in August, and when the House returned in September, Wasserman Schultz said that it was 'very important to give a substantive opportunity' to the many members who don't serve on a committee with jurisdiction over the issue. Of the 91 Democrats serving on the three committees of jurisdiction, only nine voted against final passage; by contrast, 30 of the remaining 167 Democrats opposed the bill.

Andrews, who was among the six chairmen, praised Pelosi for 'putting the committees through the committee process' and said that she 'used the committee product as the foundation to get to 218.' Committees have remained the dominant forum, he said, but Pelosi encouraged the chairmen to work more collaboratively with the caucus's rank and file. Back in 1993, when he was serving his second full term, Andrews said, 'it would have been very unlikely that [then-Ways and Means Chairman] Dan Rostenkowski would have agreed to these changes.'

Filling The Bully Pulpit

Obama's decision to have only limited dealings with House Democrats on health care reform has been the topic of controversy. White House allies can rightly assert that the president achieved his chief goal of securing House passage, but the president's sparse involvement added to Pelosi's legislative burden. House Democrats have noticed, of course, that Obama and his top aides have been more actively engaged in recent months with the Senate's bumpier handling of health reform and have worked closely with Majority Leader Harry Reid, D-Nev., in seeking to expedite that chamber's approach.

Rep. Anthony Weiner, D-N.Y., criticized Obama's hands-off approach with the House and especially his early decision to remove the single-payer system as an option. 'Many of us are disappointed that we have not had a more forceful advocate in the president,' Weiner said. He lamented the missed opportunity for a public discussion of government control and said that Obama's 'silence' affected Pelosi. 'Nancy has done as much as she possibly could have done under the circumstances,' Weiner said. 'But the discussion has been disappointing. It's tough for the speaker to do this without the president helping out.'

Welch voiced some agreement. 'The White House can offer policy coherence, in contrast to the legislative pragmatism that has resulted in some provisions of the bill being weaker than some of us would prefer,' he said.

Eshoo rejected Weiner's disappointment as 'misplaced.' She praised Obama for stating his priorities and said that the president's long-standing opposition to a single-payer system is well known. 'The president has weighed in with phone calls and the private touch, but he's not in your face,' she said. As for Pelosi, Eshoo added, 'I have never heard her complain about the president's actions. She relishes her responsibilities.'

Other Democrats said that Weiner was seeking to shift the blame for his own failure to promote his goals. Some lawmakers clearly welcome Obama's lighter touch compared with President Clinton's heavy-handed -- and unsuccessful -- management of health reform in 1993. 'This process was never going to be smooth, but it's a whole lot better than when Bill and Hillary acted like Congress was a rubber stamp,' McDermott said.

It appears likely that Obama, who joined the Democrats' Capitol Hill pep rally on the morning of the House's health reform vote, will continue to increase his involvement as the legislation approaches crucial endgame decisions. 'The president has played it exactly right,' Andrews said. 'He laid out broad policy goals, with some fundamental choices. During the next steps, he will use more of his political capital to get final approval. It is better to have 'Lyndon Johnson' show up in conference committee. Presidential leadership is substantial, but finite.'

Spreading The Message

As part of Pelosi's hands-on management of the health care reform initiative, she directed her allies and staff to undertake an active public-relations campaign.

The speaker assigned Rep. John Yarmuth, D-Ky., a newspaper publisher and columnist in his hometown of Louisville before he was elected to Congress in 2006, to lead a health reform message group of Democratic members, on which she serves. 'The speaker was putting together parts of the bill with 250 members working across committee and regional interests,' Yarmuth said. 'The messaging on this bill is unique because it affects each constituent differently. We tried to craft from day one a message that each member could deliver.'

Pelosi's aides also produced a huge trove of materials for both internal and external consumption. Often more than once a day, they e-mailed 'fact sheets' analyzing the debate; they typically included supportive comments from experts and replies to critics, plus occasional 'breaking news.' Brendan Daly, Pelosi's communications director, said that leadership staff members teamed up with aides to the three committees working on health reform. 'This is a campaign unlike any in House history,' Daly said.

Democratic aides also ran a 'health care hotline' to provide fast responses to queries from rank-and-file lawmakers' offices. 'We want to respond quickly,' Daly said. 'It's very labor-intensive, but our staff has been superb.' In one case, when a first-term Democrat's legislative aide wanted to know how the bill would affect health savings accounts, the team of press aides replied within four minutes.

As the leader of House Democrats, Pelosi has a lot at stake in the health care reform outcome. And the endgame decisions are likely to be made in an election year in which Republican leaders and strategists are increasingly optimistic that their party could win the 41 seats needed to regain the House majority.

The speaker and her advisers concede some electoral risks, but they say they are confident that their 2010 electoral losses will not come close to a party switch. Still, recent history suggests that Pelosi has grounds for caution. Each of the four speakers of the past 20 years -- two Democrats, two Republicans -- has left office because of a combination of ethical problems, re-election defeat, and poor party performance. Before that, the most recent speaker to depart ignominiously while his party still had control was Joe Cannon, R-Ill., who was largely stripped of his powers in 1910.

It's possible to imagine that the 69-year-old Pelosi, who was first elected at age 47 after raising five children, might decide to exit voluntarily to spend more time with her grandchildren. But first, she needs to complete a few legacies.