How One Lawmaker Is Deciding Health Care Vote

WASHINGTON (March 17) -- Rep. Jason Altmire refuses to make up his mind.

"It would be a disservice to my constituents," the Blue Dog Democrat from western Pennsylvania told AOL News. He vows not to announce his decision until he votes later this week on the contentious health care bill. Until then, he's listening to as many voters as possible. "Their voice needs to be heard."

And they are. Tens of thousands of e-mails have landed in his inbox. Calls to his three offices are piling up so fast that constituents are being urged to keep calling back until they get through. Protesters chant outside his office here and back home in Aliquippa and Harrison. In meetings, TV ads, church festivals, high school basketball games and restaurants while he's eating with his wife and daughters, they tell him. He's even getting messages from the sky: A small plane has been circling over his district for days trailing a sign reading, "Tell Rep. Altmire to Vote No on Health Care."

"So far, there's definitely a tilt in opposition to the bill," he said. "If that continues this week, that's going to play a major role in my decision."

That decision may be among the most important factors in whether Barack Obama is remembered in history as the president who reformed health care in this country or just the latest chief executive to fail miserably at the task.

As one of 39 Democrats who voted "no" on the bill in November, Altmire was recently mentioned by name by House Majority Whip Rep. James Clyburn as someone he'd try hard to flip to "yes" this time around. The national media hasn't been this interested in him since the then-freshman congressman did the Seminole Chop for Comedy Central's Stephen Colbert.

The pressure is building on Altmire and other "undecideds" to get the 216 votes Speaker of the House Nancy Pelosi needs to send a health care bill to the president's desk.

On Monday, Obama left a message for Altmire from Air Force One. Later on the phone, the president went over "in precise detail" changes in the bill that addressed his particular concerns about a Cadillac tax on health plans and an employer mandate to provide health insurance, Altmire said. Both have been pared back or dropped from the bill. Obama also outlined stronger measures to contain spiraling health care costs.

"The bill has evolved to a point where it's better than it was before," Altmire said. "There are things I still don't like and things I wish were in it. But I don't get a line-item veto. I just have to vote yes or no on the finished product."

Yet despite cozy group meetings in the Oval Office and regular sit-downs with party leaders -- though not, so far, with Pelosi herself -- the two-term congressman insists, "The pressure comes from my constituents," and conversations with the White House and leaders in Congress "are not nearly as important."

'Always a Tough Race'

Pennsylvania's 4th District rambles across all or part of six counties near the Ohio and West Virginia borders. It includes farms, blue-collar former steel towns and middle-class and upper-middle-class suburbs north of Pittsburgh. The Cook Political Report now paints the once solidly Democratic district a light pink in favor of Republicans. John McCain got 55 percent of the vote there in 2008 to Obama's 44 percent.

Altmire was elected in an upset in 2006 when he ousted three-term GOP incumbent Melissa Hart with 52 percent of the vote. Two years later, he widened his margin, beating Hart with 56 percent in a rematch. Though political prognosticators like Altmire's prospects this fall, "He will never have a landslide election. He will always have a really tough race," said University of Pennsylvania political scientist Kristin Kanthak.

"When he's trying to decide what to do on health care, he can't win but he really can't lose either," she said of one of the few remaining moderate districts in a Congress composed mostly of polarized enclaves of red and blue. "People are going to be angry at him no matter what he does."

A recent poll commissioned by a business group critical of the Democratic health care plan found 58 percent of voters in Altmire's district opposed to the legislation. Even more, 81 percent are convinced it will raise their taxes.

Unlike many economically hard-hit districts, PA-4 is relatively well-off when it comes to health care. According to a study by the Urban Institute, a nonpartisan think tank, just 9 percent of Altmire's constituents younger than 65 are uninsured compared to 17 percent nationwide. But Altmire's district also is one of the oldest demographically, with 135,000 people receiving Medicare; they -- like other seniors -- are worried their benefits will be cut under the Democrats' plan.

Although so many in the district already have health insurance and are unlikely to be directly affected by the bill, Kanthak said, they still worry about increases in the federal deficit and their taxes. Many of Altmire's constituents "are nervous about national government getting bigger," she said.

A Health Care Pro, Literally

Few members of Congress are better prepared to understand the fine print in the health care bill than Altmire. At 42, he holds a master's degree in health administration from George Washington University and has 15 years of health policy experience as a congressional staffer and a lobbyist for a for-profit hospital association and later the nonprofit University of Pittsburgh Medical Center.

In 1993, as a young aide to centrist Democratic Rep. Pete Peterson of Florida, Altmire was assigned to first lady Hillary Rodham Clinton's health care reform task force. David Kendall, now a health policy analyst at Third Way, served with him as one of the panel's "token" moderate Democrats who, he said, were ignored by the Clinton White House.

"He knows the health care system from the inside and out. One of the problems we have in Congress is that because health care is such a complex and expansive thing, it's easy to miss important subtleties," Kendall said. "Having had that knowledge is definitely an advantage in helping make the decisions."

The Clinton task force showed "that the risk of failure means you're going to spend years before health care is back at the table again," Altmire said. "The reality is if this doesn't pass, we're going to have the status quo and will have it for years to come. So I have to think about that."

One thing the pro-life Democrat isn't giving as much thought to is the issue of abortion. While Altmire wishes the Senate bill were "more air-tight" on ensuring no federal funds are used for abortion, he indicated that he won't follow other Democrats who vow to vote against it because it doesn't contain the stricter Stupak amendment in the House version.

"I won't vote for a bill that adds to the deficit; that's a dealbreaker. Everything else I have to look at in total," he said.

Although Altmire has voiced uneasiness with parliamentary maneuvers being considered to bypass a direct vote on the Senate bill, Kanthak predicts he will join liberal Rep. Dennis Kucinich to support the measure. His explanation will be, "I've worked hard to move this bill to the right and this is as far as it's going to get," she said.

While Republicans, including his likely challenger, Mary Beth Buchanan, are certain to paint the incumbent as a flip-flopper if he changes his vote, Altmire said he isn't worried: "This is a much different bill than the previous bill I voted against."