Displaying what has become the hallmark of her leadership style, Speaker Nancy Pelosi (D-Calif.) took a hands-on approach to crafting the compromises that produced the bare majority needed for House passage of a health care reform measure.
That meant captaining a seemingly endless series of meetings with Caucus groups and individual lawmakers over the summer and into the fall to take and retake the temperature of her disparate Caucus. And, as House Democrats closed in on their final package, Pelosi took the lead negotiating the fine print of last-minute deals to keep the bill on track.
A liberal who keeps faith with that wing of her party, Pelosi twice had to deliver tough news to her fellow travelers as she struggled to bring moderates aboard: She dumped the preferred liberal version of the public insurance option tied to Medicare rates and agreed to allowing a floor vote on a proposal from anti-abortion Democrats to add tough new restrictions to accessing the procedure.
That those decisions were as painful for Pelosi herself as leaders of the liberal bloc helped keep them from bolting on final passage. But the Speaker’s ability to convince liberal Members to pile compromise on top of compromise likely will get tested again when House and Senate negotiators meet to hash out the differences between their versions of the overhaul.
Pelosi will provide the strongest bulwark against efforts by moderate Senate Democrats to jam their priorities — such as a public option “trigger— if private insurers fail to provide affordable coverage — into a conference report.
In the end, however, the reality of the Senate’s higher hurdle for clearing the measure may dictate that Pelosi will need to sell left-leaning Democrats in her chamber on swallowing one more bitter pill for the broader goal of expanding health care access for millions and bringing insurance companies to heel.