After nearly a year of discussion, five months of committee-level drafts, two weeks of full Senate debate and 17 votes, at least a half-dozen scenarios could leave Senate Majority Leader Harry Reid one vote short of passing health care reform.
Despite Reid's announcement Tuesday night that "consensus has been reached" among Democrats on health care, consensus remains most definitely elusive on any number of issues that could scuttle reform with the loss of just one Democratic vote, keeping Reid from the 60 votes he needs to pass his bill.
Sen. Ben Nelson (D-Neb.) said Tuesday that the Senate's rejection of his restrictive abortion-funding language could take him out of play. Two moderates -- Connecticut Democrat-turned-independent Joe Lieberman and Blanche Lincoln (D-Ark.) -- have threatened to bolt if the public option stays in the package, while at least three progressives have said they won't vote for the bill without
a public-run insurance plan.
Only one realistic scenario gets Reid from 59 votes to the needed 60 -- the support of Olympia Snowe, the Republican from Maine.
Snowe was with the Democrats earlier this year on health care, when she became the only Republican to vote for the bill coming out of the Senate Finance Committee. "When history calls, history calls," she said as she announced her vote at the time.
But is history still calling the senator?
The bill has undergone significant changes since she supported it months ago. After the Finance Committee approved it, Reid took that bill, along with another version passed by the Senate Health Education and Labor Committee, and met for weeks behind closed doors with a handful of White House and Senate negotiators. The bill that emerged included higher Medicare payroll taxes and a public option, both of which Snowe opposes.
But Snowe has said she remains open to supporting the bill. She has sided with the Democrats on eight of the 16 votes to amend it, including one in opposition to Nelson's anti-abortion language and in support of an amendment from Lincoln to cut the tax break for compensation for insurance company executives.
As time ticks toward an endgame on the bill, staff conversations and back-of-the-envelope math inevitably bring Snowe's name up as a possible 60th vote for Reid if he loses one member of his wobbly caucus. The first person to raise Snowe's name is Reid himself.
While 10 Democratic senators, informally known as the "Gang of 10," huddled Tuesday in a second-floor meeting room in the Capitol to hammer out a compromise on the public option that might mollify their entire caucus, Reid met quietly with Snowe in a private office less than 20 feet away to find out what it would take to get her vote.
"I don't know," she said after the meeting. "I'm going to keep working on all of these issues. It's probably premature to answer that question."
The conversation with Snowe revealed significant differences between her and the Democrats. She is known as a methodical, detail-oriented legislator and calls the accelerated pace of the Senate negotiations "gravity defying," saying, "I think it's the timetable under which we're functioning that makes this so difficult."
Would she support Medicaid expansion, as the Democratic negotiators are considering? "No. I'm opposed to Medicaid expansion. It's very expensive," she said Tuesday. "It's a huge burden on the states."
She was equally skeptical about expanding Medicare, a second plank of the new Democratic negotiators' platform. "It's an expansion of government at a time we should be moving in the opposite direction, frankly. That's my deep concern," Snowe said. (Examining Medicare, Medicaid and other government-run health plans, Andrea Stone, of our sister publication Sphere
, notes that in some ways, the "public option" is already here.)
But key elements of the possible consensus among Democrats originated with ideas from Snowe, including the proposal to offer national nonprofit insurance plans across state lines. Another idea floated by negotiators would create a trigger mechanism to start a public option if the nonprofit plan falls short of the goal to make insurance more affordable. That, too, was originally offered by Snowe.
Snowe said she wants to work with Reid to improve the bill and send it in a direction that she can support.
Is it headed the right way? "I can't tell right now."