Kickback to the gut

WASHINGTON — Ben Nelson didn't see this coming.

From the shores of Massachusetts to the hills of Tennessee, from Ohio to California, the Nebraska Democrat has become the poster boy for the wheeling and dealing over health care. Critics continue to heap abuse on the Senate's Medicaid exemption for Nebraska, derisively dubbed the “Cornhusker kickback.”

Nelson, who declined to comment for this article, has said the exemption was misunderstood by some out of ignorance and intentionally twisted by others seeking political gain.

The furor, he told the Washington Post three weeks after he cast the crucial Senate vote on health care, caught him by surprise.

“You absolutely learn in the job,” he said. “I'm not saying ‘Woe is me.' It's the price of being the 60th vote.”

So how did it come to this? How could Nelson's bid to look out for his home state, or all states, turn so toxic, both at home and nationally?

Political observers pointed to some likely factors: the high drama of Nelson casting the deciding vote; how he chose to respond to critics; and the intrastate standoff between Nelson and Nebraska Gov. Dave Heineman, considered a potential 2012 challenger to the senator.

Add in general unhappiness with the underlying bill and the intense disappointment among some over Nelson's compromise on its language about federal funding for abortion coverage. Those compounded the perception that Nelson had sold out his principles.

Misunderstood or not, there is widespread, bipartisan agreement that the Nebraska exemption has greatly hampered efforts to sell the public on the health care legislation now stalled in Congress.

The process surrounding the health insurance overhaul was a factor in why deep-blue Massachusetts sent a Republican to the Senate last month. After covering the Massachusetts election, Time's Karen Tumulty wrote that the Nebraska exemption “may have been one of the biggest blunders in modern political history.”

“Normally, you'd be surprised if people in Massachusetts even know who the senator from Nebraska is,” Tumulty wrote. “But the number of people I talked to who brought up Ben Nelson's name, unprompted, was striking.”

Republicans have continued to take shots at Nelson.

But critics also include fellow Democrats. Ohio Gov. Ted Strickland, a Democrat running for re-election, called the deal “unseemly.”

Sen. Tom Harkin, D-Iowa, chairman of the Senate Health Committee, said the Nebraska exemption damaged public perception of the bill.

“Those backroom deals, those kind of deals like that, should never have been done. There's no excuse for that,” Harkin said.

One reason the furor has taken Nelson by such surprise may be that his attention was focused elsewhere during the course of the long health care debate.

His top priority — and perhaps greatest success — was killing a robust government-run insurance plan known as the public option, which he said could destabilize the private insurance market through which most Americans have coverage. The insurance industry is significant in Nebraska, providing more than 26,000 jobs.

Nelson also was pushing hard for tighter restrictions on federal funding for abortion coverage than those included in the initial Senate bill.

The financial hit that Nebraska and other state budgets would take from the bill's Medicaid expansion was further down Nelson's list of concerns.

Senate sources, speaking on the condition of anonymity to the Washington Post, confirmed Nelson's account that the extra Medicaid money, as one said, “isn't something he came asking for.”

The negotiations included Senate Majority Leader Harry Reid, D-Nev., and Sens. Charles Schumer, D-N.Y., and Max Baucus, D-Mont., plus White House aides.

Still, unanswered questions remain. Who proposed the exemption as the solution to Nelson's concerns? And why haven't other Senate leaders said the exemption was always intended as a “placeholder,” the way Nelson describes it?

Reid initially defended the exemption, saying: “A number of states are treated differently than other states. That's what legislation's all about: compromise.”

Asked recently about the intent behind the Nebraska exemption and whether it was intended as a placeholder, Reid simply said that the bill was the result of input from individual states.

“Different states have different needs,” Reid said.

Schumer also declined to talk about the Nebraska Medicaid provisions, telling The World-Herald: “You can talk to the people who put them in.” He didn't identify those people.

The fact that others at the negotiating table have not described the exemption as a “placeholder” the way Nelson has “feeds my theory that (Nelson's) looking for the viable, acceptable explanation and not finding it,” said Jennifer Duffy of the Cook Political Report.

Even though it's gotten the most attention, Nebraska wasn't the only state to receive special consideration in the Senate health care bill. Vermont and Massachusetts benefit from extra Medicaid funding worth more than what would go to Nebraska.

Louisiana also got a deal for extra Medicaid money, initially estimated to be worth $100 million. Republicans blasted it as the “Louisiana Purchase.” Some conservative talk radio hosts even referred to Sen. Mary Landrieu, D-La., as a “prostitute.”

Although he criticized the overall health care bill, Louisiana Gov. Bobby Jindal, a Republican, generally held his tongue after controversy broke over Landrieu's deal.

That contrasted with a very public back-and-forth between Nelson and Heineman.

Nelson and Landrieu also took different approaches in responding to their critics.

Landrieu was swift to defend the additional money for her state, saying it was necessary because a faulty Medicaid formula had been skewed by federal hurricane relief money.

“I am not going to be defensive about asking for help in this situation,” Landrieu said. “It is not a $100 million fix, it is a nearly $300 million fix. ... I am proud to have asked for it. I am proud to have fought for it.”

Again this month, Landrieu delivered yet another defense on the Senate floor: “I make no apologies. I do not back up an inch.”

Nelson, after first suggesting other states could seek their own exemptions, eventually asked that the Nebraska exemption be removed and replaced with a provision treating all states equally.

Duffy suggested Nelson would have been better off following his Louisiana colleague's no-apologies example.

“She stuck to that line and the press stopped asking her about it,” Duffy said.

In terms of dollar amounts, the Nebraska exemption probably wouldn't crack the top 20 state-specific deals in the health care bill, said Loree Bykerk, a political scientist at the University of Nebraska at Omaha. Yet it continues to attract the attention of people across the country.

“Before, they wouldn't have been able to distinguish the Nelson from Nebraska from the Nelson from Florida,” she said, referring to Sen. Bill Nelson, the Florida Democrat.

Some of the spotlight no doubt resulted from the drama of Nelson providing the pivotal 60th vote to prevent a united Republican filibuster.

“Landrieu's deal got attention, but it wasn't at the critical moment for health care when the public was really paying attention. Nor was Landrieu's vote the deciding one,” said Larry Sabato, a political scientist at the University of Virginia.

He described the Nebraska exemption as part of the normal give-and-take of the legislative process, yet called it “a big political mistake.”

“It is one of those defining moments for a politician that won't be soon forgotten, and it went national since the health care bill was topic A in the news from coast to coast,” Sabato said.

Fair or not, “Cornhusker kickback” also has a memorable pop to it.

“Labeling things — that matters,” Bykerk said.

Still, former Nebraska Sen. Bob Kerrey said he has been surprised at the level of negative backlash, particularly among Nebraskans themselves.

“It's confusing to me, frankly,” Kerrey said. “Because my presumption for the 12 years that I was in the Senate was ‘I represent Nebraska and I'm trying to get the laws written so they benefit the state.' I thought that's what a Nebraska senator's supposed to do.”

Kerrey, a Democrat, suggested anger directed at Nelson has more to do with opposition to the underlying bill.

“I'm not so sure people are angry about the provision so much as they are angry about the fact that that provision contributed to Ben saying, ‘OK, you've got my vote,'” Kerrey said.

Kerrey said elected officials fight for their constituents as a matter of course.

“Think of the deals done in Philadelphia in 1787,” Kerrey said. “Creation of the Senate itself was a deal that benefited Nebraska. New Yorkers complain about it all the time, but the Electoral College was a creation to protect small states.”

Bykerk said home-grown anger over the exemption may have something to do with Nebraskans' perception of themselves as squeaky clean. “We're supposed to be above that.”

Others said the anger in Nebraska over Nelson's actions remains closely tied to the issue of abortion.

Nelson has succeeded as a Democrat in a conservative state in part because of the support of people who are opposed to abortion.

Initially, Nelson insisted that the Senate health care bill include the same tough language as the House version on restricting federal funding for abortion.

Eventually, though, Nelson agreed to a compromise on abortion that became public at the same time as Nebraska's Medicaid exemption. While Nelson says the compromise he negotiated adequately separates federal money from abortion coverage, it was strongly denounced by Nebraska Right to Life.

Though Nelson isn't up for re-election until 2012, Duffy said he has reason to be concerned about the ongoing fallout from the health care debate.

“He put a target right in the middle of his forehead.”

Contact the writer:

202-662-7270, joe.morton@owh.com

« Metro/Region

Share