On the verge of the most fateful week in the life of President Obama's signature domestic initiative, the White House on Tuesday told House Democrats exactly what to say to sell the idea of health reform -- even as they know the final package of reforms has yet to be written.
David Simas, an assistant to Senior White House adviser David Axelrod, led House Democrats through a 13-slide power point presentation Tuesday night. The presentation was titled, simply, "Talking Points on Health Reform" (see below). It drew on policies found in the Senate health care bill and the recent changes to it suggested by President Obama.
Simas was joined by top Democratic pollster Stan Greenberg who warned lawmakers failure to enact health care reform could inflict far more political damage than pushing reform across the finish line.
According to two Democrats who sat through the presentation, Greenberg warned lawmakers rank-and-file Democratic voters will be demoralized if health care fails. That sour mood would likely result in lower-than-expected turnout. Greenberg warned Democrats that an energized Republican base, a virtual certainty this cycle, combined with a sullen Democratic base could cost Democrats even more seats than currently projected.
Greenberg knows something about what can happen when Democrats don't turn out in a mid-term elections and Republicans do. Misreading turnout models in 1994 blinded Greenberg to the coming GOP wave that swept congressional Democrats out of power. On reason Democrats were unhappy in 1994 was then-President Clinton's failure to secure comprehensive health care reform.
"We were told this is a base-on-base election cycle," said a Democratic lawmaker who sat through Simas-Greenberg presentations. "The case was: we will be much better off having something to talk about instead of defeat."
The irony of the Simas presentation is that it describes phrases and selling points on a bill that doesn't exist. For two straight days White House Chief of Staff Rahm Emanuel has been negotiating behind closed doors on Capitol Hill with top House and Senate Democrats on a set of so-called fixes to the underlying Senate bill the House must pass to advance the stalled health care reform effort.
After nearly two hours of talks in Speaker Nancy Pelosi's office, Emanuel told reporters: "We resolved a number of issues." He said may not be necessary to convene a third straight day of negotiations.
The White House hopes the House will vote on the Senate bill and the companion "fixes" legislation by March 18, the day Obama is scheduled to leave for a six-day trip to Guam, Indonesia and Australia.
Congressional Democrats chafe at the White House pressure but are moving with dispatch. House Majority Leader Steny Hoyer told NBC's "Today" show it was his "objective" to meet the March 18 deadline. Moments later, Hoyer said the actual goal was to hold a House vote before Congress adjourns for a two-week Passover and Easter recess on March 26.
Democratic aides said the schedule remains fluid and is subject to almost hour-by-hour alterations, many of them dependent on receiving precise legislative language on the "fixes" bill and concrete cost and budget estimates from the non-partisan Congressional Budget Office.
Rep. George Miller, D-Calif., told reporters Democratic leaders "hope to have something to present to the caucus tomorrow morning."
A short time later, top Democratic leadership aides knocked that prediction down flat, a sign of the semi-chaotic nature and ebb and flow of optimism and pessimism in Democratic ranks.
"No way, nothing to show our caucus yet," a Democratic leadership aide said.
Senate Majority Leader Harry Reid expressed similar optimism.
"I really believe the goal we've been seeking, health care, is going to get done," Reid said. "We don't have it all figured out, but we've made a lot of progress."
While those negotiations are achieving as-yet-unspecified "progress" House Democratic aides readily admit they don't know how many policy changes will be included in the "fixes" bill. House Democrats are also unsure what the policy changes will mean for projected tax revenues, cost savings or insurance premiums. Those variables will, of course, influence what health reform means for the federal budget.
Following today's meetings with Emanuel and other top Democrats, Hoyer said all that exists now are preliminary CBO cost figures.
"We have estimates," Hoyer said.
Even so, the White House talking points advise members to tell voters health reform "brings down costs for everyone" and provides "$1 trillion of deficit reduction over the next two decades."
But today on the Senate floor, the Majority Whip, Dick Durbin of Illinois, said the more practical goal of health care reform is to reduce the rate of insurance premium increases.
"Anyone who would stand before you and say, well, if you pass health care reform next year's premiums are going down, I don't think is telling the truth," Durbin said. "I think it is likely they would go up, but what we're trying to do is slow the rate of increase."
If health insurance premiums increase at a slower rate that could "bring down costs for everyone," but possibly not in the way many voters might expect. On $1 trillion in two-decade deficit reduction, the CBO has estimated savings of that magnitude. But it has cautioned those projections may not pan out as there are too many variables in estimating cost-savings over that many years.
The talking points also advise Democrats to tout the newfound "control" Americans will have over health care.
"I don't believe," page 2 of the slide show suggests Democrats say, "we should give the government or the insurance companies more control over health care in America. I believe it's time to give you - the American people - more control over your own health insurance."
Page 3 of the White House presentation also advises Democrats on how to talk "to the 85 percent with insurance," suggesting they highlight the bill "holds insurance companies accountable" and give voters "more insurance choices."
The slide show also advises Democrats to narrow the philosophical differences between Republicans and Democrats on health reform, suggesting the following line: "Despite all that we agree on and all the Republican ideas we've incorporated, many Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies." To drive home the point, Page 6 of the slide-show underlines "more or less oversight of insurance companies."
The White House presentation also addresses the controversy over using Senate procedures to move a "fixes" bill through the Senate on a simple-majority vote through a process known as reconciliation.
Reconciliation is OK, the document says on Page 12. "This is about giving Americans what they're entitled to: a clear vote showing what people stand for and believe and where the majority vote rules."
On the underlying issue of job creation, the White House slide show says health reform "Helps small businesses so they don't have to chose between hiring and health care - More jobs."
The slide show also attempts to refute "attacks" such as "The American people oppose this reform. They don't want it." A cross-section of polls on health care can be found here.
On page 13, the document lists 8 component parts of health reform tested by the Kaiser Family Foundation and finds "more likely to support" ranging from a low of 57% to a high of 73%.
The slide show concludes with a full page listing "benefits" that voters will enjoy immediately. It includes ending the dropping of coverage or exclusions of coverage for pre-existing medical conditions, an end to lifetime and annual limits on health care benefits, and a requirement that insurance plans cover dependent children until age 26.
Fox Senior House Producer Chad Pergram and Senior Senate Producer Trish Turner contributed to this story
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