House poised for historic vote

By Lisa Mascaro

Friday, Nov. 6, 2009 | 2 a.m.

The long, national health care debate is about to come to an end, at least in one chamber of Congress. But it is not drawing to a close quietly, not without one last fight.

The House is preparing for a weekend vote that cannot come quickly enough for Nevada’s Democratic lawmakers. After six months consumed by health care, Democratic Reps. Shelley Berkley and Dina Titus are ready to cast their ayes and move on to fixing the economy and bringing jobs to the state.

But Republican opponents of the health care reform bill, including Nevada’s Rep. Dean Heller, are not about to accede to the majority vote.

Stirring the opposition is making Republicans popular in the conservative wing of their party.

Heller and fellow Republicans greeted thousands of reform foes at the Capitol on Thursday. Moments before the lawmakers bound down the West steps, the crowd chanted “Kill the Bill” and “You lie!” — a nod to the conservative congressman who interrupted President Barack Obama’s congressional address with that interjection.

If Republicans can defeat Obama’s signature domestic policy priority, or at least continue rousing opposition, they may have a route to improving their dismal ratings among voters.

Nevadans have mixed views on health care reform, and conversations in town-hall meetings and over the phone lines at tele-town halls have expressed the divide.

Polls show Nevadans are divided on whether Congress should go forward with health care reform, with a slight majority opposed. But, conversely, a slim majority of Nevadans also support a key piece of health care reform — the public option, a government-run insurance company that could compete with private insurers for some customers.

Nevadans’ health insurance premiums have more than doubled since 2000 and even though most of the state’s residents have insurance through their employers, 460,000 Nevadans are uninsured — a number that is likely rising with the climbing unemployment rate.

Perhaps no member of the House has balanced this political divide in Nevada more adeptly than Democratic Rep. Dina Titus. The freshman congresswoman represents politically split Southern Nevada, where independent voters decide elections. She won with less than 50 percent of the vote last fall, and could face a difficult reelection campaign in 2010.

Titus opposed the House health care bill in committee, making a name for herself as one of a few Democrats to buck their party. It was a smart move. Her predecessor had been branded as towing the party line, and she showed early on she is not a foot soldier for the Democratic leadership.

Titus had concerns about the proposed surtax on upper-income households, those making more than $280,000 for an individual and $350,000 for families, to pay for subsidies for the uninsured. Only when the new bill lifted that threshold to $1 million for families and half as much for individuals did she announce her support this week.

Titus also leaves a valuable imprint on the bill. She passed an amendment in committee to allow more small businesses to buy policies from the new health insurance exchange. The amendment was popular and expanded in the final House bill.

“The new bill has a lot of improvements and I’m glad to have been part of it,” Titus said this week. “I’m ready to vote for it and move on to creating jobs.”

The health care debate has consumed Washington, and the Nevada delegation, since spring.

Having devoted so much time to Obama’s top legislative priority may come with a price. Voters are expressing unrest over the continued economic turmoil, particularly acute in Nevada, where the unemployment rate has doubled from last year and is nearly 14 percent in Las Vegas.

Democratic Rep. Shelley Berkley has had differences with her party on several aspects of health care reform, but she is satisfied enough with the final product to support it.

“If I had it to do myself I would have done it a little differently,” Berkley said this week in the halls of the Capitol.

Berkley has wrestled with the party over pay formulas for doctors and taxes to pay for reform. She and Titus both opposed the president’s initial suggestion that charitable giving and mortgage interest tax deductions be limited for high-income earners — a proposal the White House eventually abandoned.

The Las Vegas congresswoman has met with dozens of groups including doctors, hospital representatives, nurses and families whose loved ones have debilitating illnesses. She has spoken to thousands of residents.

With 460,000 Nevadans without health insurance, Berkley said, it is time for Congress to act.

“I’ve got too many other things that need attention,” she said Thursday, including “a seriously eroded economy.”

But Heller is not quite done with the debate.

The congressman has made it clear he opposes the Democratic health care bill. His dozens of tweets via the social networking Web site Twitter on Monday noted what he sees as problems with the massive piece of legislation.

“Page 131 creates new federal bureaucracy — a ‘Health Choices Administration’ and a ‘Health Choices Commissioner,’ ” he wrote in one representative post.

Heller is among the Republicans who see the proposed health care legislation as what he calls a “massive government expansion.”

But the congressman’s battle now is over the issue that has given him the most notoriety in this debate — his pursuit of restrictions on illegal immigrants receiving health benefits.

The bill prohibits illegal immigrants from accessing government-subsidized care, and Heller’s claims were once labeled by Newsweek as among the top lies in the health care debate.

Yet the second-term congressman has had success in this arena, getting cheers from fellow conservative Republicans and even a nod from the White House. His earlier push to amend the bill to include a citizenship verification system was dismissed by a committee. But after the White House suggested as much, House Democrats added a similar provision to the new bill.

Heller is now pushing for further restrictions on illegal immigrants. Today, Heller is scheduled to stand beside Rep. Joe Wilson — the South Carolina Republican who interrupted Obama with “You lie!” — in a call for further amendments to bar immigrants.

Heller has also joined Wilson to push for a requirement that members of Congress use the public option.

Conservative politicking has been a tactical shift for Heller since coming to Washington.

Once considered a moderate by his Nevada colleagues, Heller moved to the right after almost losing the primary to a conservative during his first bid for Congress in 2006. Whether Heller’s new alliance with the Joe Wilson wing of the Republican Party will prove smart politics in his mostly rural Nevada district remains to be seen. He appears headed for an easier run in 2010 as no formidable candidate has emerged.

As the House prepares for the possible weekend vote, the health care debate is far from over. The Senate has yet to bring a bill to the floor, and the debate could extend into next year as the two chambers would need to reconcile their legislation into one bill that could go to the White House for Obama’s signature.

With the 2010 elections just around the corner, prolonging the debate is no help to the party in power, which needs to mark accomplishments.

“I hope that doesn’t happen,” Titus said. “I think people really have health care fatigue. We’ve got to start talking about jobs, jobs, jobs.”