Every Vote Counts: “Buying” Health Care Legislation in the Senate

In my last post I discussed the politics underlying today’s vote to invoke cloture in order to bring health care to the Senate floor for debate. Because it appears that not a single Republican Senator is likely to support bringing health care to a vote, Democrats must retain all 60 members who caucus with them in today’s vote.

With the margin so small – even one Democratic defection can sink this legislation – individual Senators are in a tremendous position to leverage their vote to extract tangible benefits from the party leadership.  These are the “side payments” I talked about yesterday that can be used buy the votes of wavering Senators who might otherwise be ideologically opposed to health care reform.

And that is precisely what appears to have happened. Media reports suggest the following four Democrats have not yet committed to voting yes today to invoke cloture:

Sen. Ron Wyden, (OR)

Sen. Mary Landrieu (LA)

Sen. Blanche Lincoln(AR)

Sen. Joe Lieberman (CT)

Lincoln is one of the five Senators whose roll call voting record suggests they are located near the pivotal 60th position on the Senate’s ideological spectrum – pivotal because it requires 60 votes to invoke cloture and end a filibuster in that chamber. The other three are ideological moderates within the party, but sit closer to the median voter position within the Senate. All arein a particularly advantageous position to extract some reward for siding with the party leadership. And, (courtesy of ABC’s The Note), it appears that is what has happened.  Landrieu has previously expressed concern that the health care legislation may drive up Medicaid costs in her state. (Medicaid is a joint federal-state program that provides health insurance for low-income families and is a huge budget-buster already for many state budgets, particularly poorer states like Louisiana that have a greater proportion of low-income residents.)

Now turn to page 432 of the health care bill, which, according to The Note, spells out some of the conditions for a state to receive a boost infederal Medicaid subsidies.  The relevant language, tucked in the legislative jargon, is as follows:(2) In this subsection, the term ‘disaster-recovery FMAP adjustment State’ means a State that is one of the 50 States or the District of Columbia, for which, at any time during the preceding 7 fiscal years, the President has declared a major disaster under section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act and determined as a result of such disaster that every county or parish in the State warrant individual and public assistance or public assistance from the Federal Government under such Act and for which …”

Hmmm…a state that underwent a major disaster in the past seven years.  Thinking….thinking….could it be Landrieu’s state of Louisiana? Evidently, yes; if the Note is to be believed, Louisiana is the only state that qualifies under this legislative language for a boost in federal Medicaid subsidies.  The cost of implementing this language?According to the Congressional Budget Office: $100 million.

Will that side payment be enough to win Landrieu’s vote?  We’ll know by this evening.

But it is a nice illustration of the power of the moderate middle in a highly polarized Congress to leverage uncertainty over their vote as a means for acquiring side payments.  Note that, even though every Senate Democrat’s  vote is crucial, not every Democrat is equally capable of extracting concessions from the party leadership.  To do so, a Senator’s threat to defect has to be credible, or else the party leadership will simply call the Senator’s bluff. Evidently Landrieu’s threat was deemed credible.

If I get a chance I’ll be on a bit later to discuss the likely voting patterns one more time.  The actual Senate vote doesn’t occur until this evening, but we should know before then how it is likely to play out.

CORRECTION:  I incorrectly listed Blanche Lincoln as representing Nebraska – as Midd Alumn points out, she’s representing Arkansas.  Thanks for the catch – I’ve corrected it above.


  1. First, to address a small typo – although Lincoln is the capital of Nebraska Senator Lincoln is from Arkansas, a fact Dickinson previously noted correctly. Which leads to my real question, if there these bonuses to be had is there any reason a Senator would NOT try and take advantage of them? I’m specifically thinking of Senator Ben Nelson, who you spoke about in your last post as having a fairly important position in tonight’s vote, but who has already declared his intent to vote with the Democrats.

  2. It’s amazing that the Democrats hold a margin of 81 votes over the Republicans in the House yet the vote only passed 220-115. I remember learning about how the parties, over the last thirty years, became more polarized and party-line voting adherence increased. Understandably on a controversial issue where hundreds of millions of dollars were spent lobbying law makers accompanied by the most expensive television ad battle, it would be less party-line voting.

    Because it was so close on the House side any Senate health care bill that has a chance to make it to reconciliation is going to have to be far more moderate than the House bill. Landrieu was just reelected in ’08 so I assume she has more insulation from electoral repercussions than others might. Nelson is up for reelection in ’12, but Lincoln is up in 2010. According to one polling site, Lincoln’s average polling data is 41.3 to her opponents 41. Meanwhile Arkansas went 59-39 for McCain in ’08 meaning it will be electorally harder for Lincoln to vote yay unless she is given a big carrot.

    Reid has done a lot to make the Senate version more moderate (costs less, deficit neutral, CBO projections to cut the deficit by $130 billion over first decade, up to $650 billion over second, delivery reform, etc.) and he has done other things like proposing refunding abstinence only sex education–maybe in an attempt to win over more moderates/conservative Democrats like allowing the Stupak-Pitts amendment to be voted on in the House.

    I think that the Senate will produce a health care reform bill, but what is in it is a different story. These moderates who hold the power are obviously going to exploit there power to win concessions to make voting yay for it more acceptable with their already split constituencies. Meanwhile, I’m really interested to see if and when the Senate passes a bill, how reconciliation will be. I would assume that the Senate would have more power in negotiations because House members are A. up for reelection every two years and want to show they didn’t just waste months of time on a failed legislative initiative, and B. the House probably will concede more because Dems have a larger majority willing to make it more moderate to get something passed (unless you’re Dennis Kucinich and you vote against it because it’s not liberal enough).

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