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Word On The Hill: Don't Count On Nelson's Support

Except for the arguments over whether to create a public insurance option, the health care debate is still in what one prominent expert has called the “kumbaya” phase. Traditional opponents of reform are not yet attacking. Supporters of reform are stressing their common beliefs. Things will change once actual legislation emerges and inevitable differences over the details emerge. But, for now, everybody is playing nice.

Everybody, that is, except for Nebraska Senator Ben Nelson. Nelson, a Democrat, distinguished himself a few weeks ago by voting against his fellow Democrats on the budget. Now, it seems, he’s prepared to do the same when the Democrats put forward their proposal for health care reform.

Several Capitol Hill sources have told me that Nelson’s staff have put out the word that their boss is skeptical. Really skeptical. According to one source, who read me notes of a recent discussion, a Nelson staffer boasted that “Democrats will have to earn [Nelson’s] vote” on health reform and that Nelson is “fully prepared to vote against it.”

This Nelson staffer (again, according to my source) couldn’t imagine the senator supporting a comprehensive proposal like the one Democratic leaders, including President Obama, favor--that is, a combination of subsidies, sweeping insurance regulations, and far-reaching payment reforms designed to make sure everybody can get affordable insurance. Such an ambitious package, the staffer suggested, would probably get five or six Republican votes before it got Nelson’s.

I ran this by Jake Thompson, Nelson’s spokesman. Thompson wouldn’t comment on what individual staffers were saying, but noted that his boss has been discussing reform with Senate Finance Chairman Max Baucus, who is spearheading the drive for comprehensive reform and has already outlined such an approach in an official white paper.  According to Thompson, Nelson considers the Baucus proposal “a very good beginning.” Nelson is “concerned about the overall cost of health legislation, but he’s definitely working with Senator Baucus to make improvements to it.” Thompson added that Nelson hasn't drawn any lines in the sand.

I obviously can't say for certain what Nelson feels in his heart. Maybe the staffer was just blustering. But it'd hardly be surprising if Nelson were fighting his party on health reform. He’s the most conservative Democrat in the Senate, representing one of the more conservative states in the country. 

Still, many conservatively inclined voters are giving comprehensive health care a serious look nowadays, for the very simple reason that the crisis of dwindling access and rising costs is affecting everybody, one way or another.

Even in Nebraska.

In a May, 2008, poll sponsored by the Nebraska Medical Association and conducted by KRC Research, a fourth of respondents said they went without insurance at some point in the previous two years* and a third said they skipped recommended medical care because it was too expensive. Overall, 90 percent of the Nebraskans surveyed said they supported “an affordable health care plan for all--regardless of health status.”

Granted, those numbers are probably soft. Enthusiasm for reform would surely fall as people understood the mechanics of such a plan. But it certainly seems like Nebraska voters want their elected representatives to make a good faith effort at passing comprehensive reform. And it doesn't seem like Nelson is doing that.

*Note: In case you were wondering, the Kaiser Family Foundation reports that 13 percent of Nebraskans lack health insurance, according to the latest data. That's roughly consistent with 25 percent losing insurance over a two-year period, given the pattern observed in other studies.

--Jonathan Cohn

Image courtesy of Chip Somodevilla, Getty Images