The House just passed Fred Upton’s bill. He calls it the “Keep Your Health Plan Act,” because its ostensible purpose is to make sure people losing their existing health plans can keep them. It might or might not have that effect. But an equally accurate description would be “Go Back to the Old Lousy Health Care System Act.” Under its provisions, insurers could keep denying coverage to people with pre-existing conditions, continue selling policies that have huge gaps, and so on. These are the sorts of practices that even most Republicans say they want to prohibit.
But it’s not the bill’s name that makes it newsworthy. It’s the vote tally. It passed with 261 votes, 39 of them Democratic. That’s about one-fifth of the House Democratic caucus.
The number was lower than Republicans and even some Democrats had predicted. (Reminder to political observers: Never bet against Nancy Pelosi.) The tally is also only five higher than the number of Democrats who voted for the Affordable Care Act in 2010, though the caucus was bigger back then. But the defections are a tangible signal of Democratic anxiety over plan cancellations, website problems, and the toxic blending of the two. Yes, Democrats are always nervous—it's second nature. But in this case the political fear is more palpable and it has a basis in reality. People are getting cancellation notices and few have easy access to the alternatives—which, in many and possibly most cases, will seem preferable to what they have now. That has created a loud, angry, and influential constituency. House Democrats are bound to pay attention, particularly when polls suggest they've completely lost the advantage they gained during the October government shutdown.
The Upton bill itself isn’t going to become law anytime soon. The Senate won’t take it up and, even if the Senate passed it, Obama would veto it. (Obama’s formal veto threat, issued Thursday, probably made it easier for some Democrats to vote for the bill, since they know it wouldn’t have actual policy implications.) But several Democratic senators are talking about their own legislative fixes. The most well-known of them is the one proposed by Mary Landrieu of Louisiana. Unlike the Upton bill, it would not allow insurers to keep selling substandard policies or avoiding high medical risks. But it would compel insurers to renew old policies, rather than leave renewals at the insurers’ discretion. That’s problematic for a whole separate set of reasons.
This is a familiar role for Landrieu, a red state Democrat who is usually among the first to break with her party. And there’s no reason to think that either she or her staff have thought particularly hard about what far-reaching effects her bill might have on the health insurance market more generally. But after the president’s announcement on Thursday, when she addressed the press, she did something very interesting: She gave a full-throated defense of the Affordable Care Act itself, hailing the security it would bring to millions of Americans and insisting her goal was merely to fix what she believed were the law’s problems, not wreck it altogether.
That rhetoric is also an important political barometer: It suggests that most Democrats want to protect themselves on the plan cancellations, but aren’t looking to sabotage the law itself. It had echoes in the House chamber, where the majority of Democrats were similarly strong in their condemnations of Upton’s proposal—precisely because it would allow the old, unpopular insurance practices to survive. Brian Beutler summarized the politics well in his dispatch for Salon, knocking down reports of a new Democratic "civil war":
Obamacare has a real problem—an enrollment bottleneck created by Healthcare.gov’s failure—and the truth is the wave of cancellations wouldn’t have been easily brushed off even if the website had been working perfectly. Together they’ve driven some Democrats into conflict with one another.
But the conflict isn’t especially deep. Ask congressional Democrats whether they support Sen. Mary Landrieu’s bill to require insurance carriers to reinstate canceled policies. Some will say no, some will say yes, some will have a different plan that they like better. Deep down they know that a ham-fisted solution shouldn’t become law, but they don’t feel like they can be caught supporting nothing either.
Ask them, by contrast, if they support the Affordable Care Act, or think it should be repealed, or regret their votes for it, or believe it can be fixed, or anything like that, and they’re unanimous. ...
We’ll know Democrats are warring with each other, or in full retreat from the law, when Harry Reid and Nancy Pelosi can’t restrain rank-and-file members from forcing legislative sabotage on Obama. That hasn’t happened yet. Obama’s administrative fix staved it off for the time being. But the scenario’s not outside the realm of possibility if the relaunch isn’t smooth, and enrollments fail to reach escape velocity.
The political danger for Democrats is real—very, very real. But right now most members, even those proposing modifications, are standing by the health care law. They still want to make sure all Americans can get decent health insurance. The Republicans don't. That was clear before today's vote and its even more clear now.