Healthcare reform backlash: Americans angry over earmarks

"There are a hundred senators here, and I don't know if there is a senator that doesn't have something in this bill that was important to them," he said in a Dec. 21 press briefing. "And if they don't have something in it important to them, then it ... doesn't speak well of them. That's what legislation is all about: It's the art of compromise."

That comment went viral, too.

Sen. Ben Nelson (D) of Nebraska held out the longest before promising his vote. He negotiated a deal that exempted his state from paying the costs of expanding access to Medicaid. A new federal mandate involving Medicaid would cost Nebraskan taxpayers $450 million over 10 years, state officials said.

But Nebraskans reacted sharply to the news that their state had been singled out for special treatment. "We don't like special deals," Gov. Dave Heineman (R) told Fox News. The governor's office reports that it was overwhelmed with phone calls on the issue, mainly opposing the deal.

In an unusual move for a lawmaker not up for reelection, Senator Nelson ran television ads explaining his vote in favor of the bill. Now back in Washington, Nelson says he is discussing with Senate leaders and others how to change the bill to make sure all states are treated equally.

"This was never just about Nebraska," he said in comments to the Monitor. "It was to be a placeholder to try to get [the Medicaid extension] fully funded for all states. My priorities are Nebraska first, Nebraska always – not Nebraska only."

Senator Landrieu, too, said on Thursday that the deal worked out for her state could also help others that in the future face Katrina-scale disasters.

"This is not a special day for Mary Landrieu. This is a fair deal for the people of Louisiana, and it was never a condition for my vote," she said in an interview.

When the White House got involved in brokering compromises with key stakeholders, it also roused public anger. Facing rebellion in trade-union ranks over the Senate bill's tax on high-end insurance plans, the White House negotiated a deal exempting union workers from the so-called Cadillac tax until at least 2018. Critics characterized it as special treatment for a key Democratic constituency. Union officials say it's standard practice.

"It's typical when a federal law goes into effect that makes a major change that affects workers and workplace practices to provide for a transition period for collective-bargaining agreements," says Gerald Shea, a spokesman for the AFL-CIO. At least a dozen major bills in the past five years have had similar provisions, he adds.

On the other hand, some reports about healthcare deals for a particular state turned out to be false. Sen. Bernard Sanders (I) of Vermont faced a wall of complaints that he had secured $10 billion for his state in exchange for his vote. Earlier, Senator Sanders had threatened to vote down any bill that did not include a robust public option.

In fact, the $10 billion was to expand government funding nationwide for community health centers and the National Health Service Corps. The provision, which had some bipartisan support, benefited underserved rural and urban areas.

"Still, it somehow got out that this was part of the plain, ugly deal cutting and logrolling on Capitol Hill," says Sanders spokesman Michael Briggs.

So why all the special scrutiny of healthcare reform? It's the size and scope of the legislation, affecting individual lives and one-sixth of the US economy. "We have never seen the process of complex legislation viewed as upfront and personal until now," says Sen. Patty Murray (D) of Washington, a member of the Senate Democratic leadership. That's "because it's personal," she adds. "Every single person in America is affected by this healthcare bill."

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