Blue Dogs dig in as influential bloc in health care debate

WASHINGTON -- In many ways, President Barack Obama's address to Congress on Wednesday was aimed at lawmakers like Georgia Reps. Jim Marshall and Sanford Bishop -- fiscally conservative Democrats who represent rural enclaves and small towns in ideologically moderate to conservative Southern districts.

"In my opinion, the demographics of the Blue Dog Coalition reflect more accurately the demographics of the entire United States of America," Bishop said. "Most Americans are centrists. Where I come from the values are God, country, family, work and guns, and not necessarily in that order."

During his speech Wednesday night, the president sought to assuage the concerns of the Blue Dogs -- a group of 52 moderate to conservative House Democrats from largely rural or small-town districts -- by highlighting the administration's goals of reining in spending by eliminating Medicare and Medicaid fraud. Obama also reached out to centrists by scaling back proposed costs to $900 billion over 10 years -- some House estimates had put the plan at $1.2 trillion.

Obama also touched on medical liability reform and relaxed his stance on a government-run public health care option -- the so-called "public option" -- by highlighting the broader goal of insuring Americans as more important than offering a government-run plan. All are issues that, as Bishop put it, are "principles that are consistent with the Blue Dog principles."

The Blue Dogs "have emerged as the pivotal group on health care reform because of the fact that the process has worked out in such a way that there's not much cooperation between party lines," said Randall Strahan, a political science professor at Emory University in Atlanta.

The group is far from unified in its support of the administration's efforts.

For example, Marshall has deep misgivings about a public option, in part because he questions whether such an option would fully address cost overruns and fraud. He'd prefer to direct congressional efforts toward addressing the high cost of health care and steer the nation to a system in which consumers have greater control of their own health care choices.

"I find this argument of public versus private to be a false argument. It misses the point," Marshall said. "Any system which has a great deal of central planning is bound to have terrific inefficiencies. I haven't bumped into too many people who were thrilled with having to deal with a private insurance company when they're ill, and I haven't bumped into too many people who were happy with Medicare and Medicaid."

Bishop, on the other hand, remains open to the idea of a public option. But he's willing to consider alternatives in order to achieve improvement, such as member-owned, non-profit health cooperatives that negotiate directly with a network of health providers.

"I personally think they misunderstand the public option," Bishop said. "If (Obama) does not convince the people in the Senate that it is not a government takeover and scheme, there won't be enough votes to pass it. If a co-op would satisfy those people's irrational fears, we should develop that or some other mechanism. Whether you call it an elephant, zebra, public option or co-op, as long as it has the effect of driving insurance premiums down then it serves the purpose. Insurance companies have to feel the competition."

Such differences make wooing this critical bloc a challenge for both the administration and the Democratic leadership. In the House, Speaker Nancy Pelosi's office must balance the desires of a large group of Democrats who are wedded to the public option and roughly 50 moderates who are less supportive of that, Strahan said.

In the interim, the Blue Dogs are flexing their political muscle.

The group, many of whom hail from the South and Midwest, pushed "rural health equity" with higher reimbursement rates for physicians and hospitals in areas of the country that struggle to recruit and retain health care providers. Earlier this year Marshall and Bishop, along with other Blue Dogs, expressed concern about the pace, shape and cost of the overhaul and effectively helped stall legislation until the fall.

Ostensibly, the delay was geared toward providing lawmakers an opportunity to go home and talk with constituents in open forums about the matter during the August recess.

Those lawmakers returned to Washington armed with feedback from this summer's series of contentious health care-themed town hall meetings and gave decidedly mixed reviews to Obama's evening address to a joint session of Congress.

"The House proposals would have to change pretty dramatically," Marshall said. "There are some Blue Dogs that feel the public option is the only way to go. There are other Blue Dogs who are adamantly opposed to a public option. If a public option is in the bill, they'll vote against the bill. The vast majority of us are concerned that the House bills do not control costs."


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