Hello Scott Brown Goodbye Filibuster-proof Healthcare Reform

Healthcare reform, which appeared to be inevitable a few short weeks ago, has been dealt a major setback. Yesterday, the state of Massachusetts held a special election to fill the late Ted Kennedy's Senate seat. In a sad irony for those seeking to change America's individual health insurance system, the staunch reform advocate was replaced not by Democrat Martha Coakley, but by a Republican, Scott Brown. Brown largely campaigned on his opposition to health care.

Independent voters have soured on the seemingly endless debates over healthcare reform. The economy, including a 10% unemployment rate, have been their primary concern. Many Democrats believe that healthcare reform is closely related to jobs--they feel that small businesses, which create the majority of jobs in the United States, are more likely to be launched if potential entrepreneurs no longer have to worry about finding affordable self employed health insurance. However, they have failed to convince the voting public of those potential benefits.

The results mean that the Democratic party has lost its filibuster-proof majority in the Senate. With 41 votes, Republicans can now block the healthcare bill. Majority Leader Harry Reid has vowed that he will not delay Brown's swearing-in; such a move would have potentially catastrophic political consequences. For Democrats up for re-election this year, the climate is already hostile. The White House is understandably worried about this near-fatal blow to the centerpiece of President Obama's domestic agenda.

Staffers have pointed fingers at Coakley for running an incompetent campaign, which featured several notable gaffes and relatively little on-the-ground action. On the other hand, Coakley employees have blamed the national party and White House for providing only last-minute support (Obama made one stump speech on her behalf) and the delay in passing health insurance reform that has allowed the public to become ever more impatient. Several weeks ago, Coakley had a significant lead in the polls, but it was largely squandered as congressional committees continued to coincide their bills with seemingly little progress. Both sides certainly played a role in the loss.

Massachusetts has more experience with medical insurance reform than most states. For several years, the state has had an individual health insurance mandate. The mandate, which is somewhat similar to the current Senate proposal, requires that all residents either buy health insurance or pay a fine. It also offers subsidies to help individuals and families making under a certain annual income buy coverage. Medicaid and Medicare insurance are also available. Although it has resulted in a significant reduction in the percentage of uninsured residents, costs have continued to rise under Massachusetts' healthcare reform. (While the Senate has proposed further cost control measures beyond those used in Massachusetts, liberals in the House have long opposed some of them--such as the tax on high-cost insurance plans, which would hit mainly Democratic union voters hardest.) It is possible that personal experience colored their vote.

Exit polling bears out this notion; the polls show that nearly half of Massachusetts voters were primarily concerned with healthcare reform, as opposed to Obama's general agenda. In fact, the majority of Massachusetts voters approved of his performance, both in general and on other specific issues (e.g. the war in Afghanistan and the economy). Thirty-nine percent of voters claim that Brown's opposition to health insurance reform was behind their vote. Coakley's lack of personal appeal and perceived negative campaign tactics also made an impact.

In what many have considered the epitome of a blue state, such emotions should be heeded. Prominent Republican politicians and spokespersons have taken the vote as further evidence that individual health insurance reform should be scrapped entirely. However, doing so would be even more humiliating for Democrats, whom have already spent so much political capital on the measure. The most likely option for Democrats is to convince the House of Representatives to vote for the Senate bill as-is, allowing it to reach Obama's desk for him to sign it into law. Such a move is legal and would require no new vote on the measure; temporarily appointed replacement James T. Kirk's yes vote would stand. However, doing so runs the risk of stoking further public anger, due to the perception that they are going against the public's wishes. In addition, the House has presented many of their own adjustments to the bill, which would be thrown out in such an arrangement.

House progressives, whom already feel as if they have given up a lot in the negotiations (such as the public option), may not want to vote for the less expansive Senate bill. They may be convinced to give in at the prospect of passing legislation to provide low cost medical insurance to millions of uninsured Americans, especially since a new vote with Brown seated may likely kill the bill entirely. Meanwhile, some centrist and conservative Democrats in the House of Representatives are unhappy with what they consider as weak restrictions on abortion coverage in subsidized individual health insurance policies. Some Democratic representatives or senators up for re-election may also switch sides and vote against the legislation in any potential re-vote. Doing so may hurt them with the electorate even more, because it will paint them as flip-floppers.