Down Three Votes in the House, Obama's Health Reform Faces 'Tricky Path'

The future of the massive bill could come down to a handful of votes.

When the health care reform bill passed the House in November of last year, it squeaked by with a five-vote margin, 220 to 215, with 39 Democrats voting no and one Republican, Rep. Joseph Cao of Louisiana, voting for it.

Since then, three House Democrats who voted for the measure have left Congress and have not been replaced: Rep. Neil Abercrombie (D-Hawaii), who announced he's resigning to run for governor of Hawaii, Rep. Robert Wexler (D-Fla.), who resigned to run a think tank, and Rep. John Murtha (D-Pa.), who died from complications following gallbladder surgery.

In addition to the newly missing Democratic votes, two underlying policy issues have tied House and Senate negotiators in knots for months-- the question of how to pay for reform and language restricting abortion financing. In both cases, the White House came down on the Senate's side, creating a scenario in which House Democrats who voted for health care reform last year could find a Senate-heavy bill impossible to support.

Rep. Joe Courtney (D-Conn.) spent months fighting against the excise tax that passed the Senate only to see it included in the president's plan Monday morning. The congressman points out that although the White House has modified that tax since Senate passed it, it would not go into effect until 2017, two years after a possible second term for President Obama ends, and well into a new health care reform system that could have unknown consequences.

Courtney said he remains concerned that the tax will hit middle-class workers whenever it goes into effect. "I don't even know how the CBO can estimate the revenue, let alone where it lands and who it impacts," he said. " To some people I might sound like an ingrate, but I just think we should go the last step and push the whole idea off until we have a better understanding of how this would affect people."

Courtney voted for health care reform the first time, but has not committed to vote for it again.

In addition to the excise tax, House leadership aides acknowledge that the impasse between the House and Senate over the language on abortion financing has not been resolved. "Stupak could be a problem," one House leadership aide said, referring to strict abortion-financing language championed by Rep. Bart Stupak (D-Mich.), supported by 40 fellow Democrats and passed by the House.

Instead of the Stupak language, the White House chose to include a less restrictive amendment authored by Sen. Ben Nelson (D-Neb.), a move that the Conference of Catholic Bishops called "morally unacceptable." On Monday, Stupak called the Nelson language in the president's new plan "a significant departure from current law and unacceptable."

In their plans to make up for the three lost votes and any possible defections, House aides are hoping that the removal of the public option from the compromise bill might sway some of the moderate Blue Dog Democrats, who opposed the House's original measure because it sought to create a government-run insurer, to vote in favor of it the second time around. Retiring Blue Dog Democrats without a re-election campaign to worry about will be at the top of the list of lawmakers that Democrats will urge to switch their votes.

Should no Democrats change their minds, the loss of the three members would put the first test vote at 217 to 215, making Cao, the lone Republican to support the bill last year, the swing vote for its final passage. But as a man who once aspired to be a Catholic priest, Cao said that the Stupak abortion language, as well as the endorsement of the Catholic Bishops, were crucial to moving his vote to a "yes."

As Courtney said from his vantage point Monday afternoon, "Obviously, the president still has a tricky path ahead of him. This is far from over."