Democrats in House a step closer to health-care vote

WASHINGTON

After weeks of turmoil, House Democrats reached a shaky peace with the party's rebellious rank-and-file conservatives yesterday to clear the way for a vote in September on sweeping health-care legislation.

Bipartisan Senate negotiators reported progress, too, on a bill said to extend coverage to 95 percent of all Americans without raising federal deficits.

"We're on the edge. We're almost there," said Sen. Charles Grassley of Iowa, the senior Republican involved in the secretive talks, although a fellow GOP participant, Sen. Mike Enzi of Wyoming, dissented strongly.

Sen. Max Baucus, D-Mont., the chairman of the Senate Finance Committee, said that preliminary estimates from congressional budget experts showed the cost of the emerging Senate plan was below $900 billion and would result in an increase in employer-sponsored insurance -- conclusions that may reassure critics who fear a bloated bill that prompts businesses to abandon the coverage they currently provide.

Across the Capitol, House Democratic leaders gave in -- at least temporarily -- to numerous demands from rank-and-file rebels, so-called Blue Dogs from the conservative wing of the party who had been blocking the bill's passage in the last of three committees.

The House changes, which drew immediate opposition from liberal legislators, would reduce the federal subsidies designed to help lower-income families afford insurance, exempt additional businesses from a requirement to offer insurance to their workers and change the terms of a government-insurance option.

At their core, both the House bill and the plan under negotiation in the Senate are designed to meet President Obama's goals of spreading health coverage to millions who now lack it, while slowing the skyrocketing growth in health-care costs nationally.

The White House issued a statement praising the develop­ment in the House, and with appearances in North Carolina and Virginia, the president tried to minimize the significance of the slippage in his timetable.

In his appearances, Obama stressed that any legislation he signs will include numerous consumer protections, including a ban on insurance-company denials of coverage based on pre-existing medical conditions. A White House fact sheet left room for insurers to continue charging higher premiums based on prior health problems.

Rep. Mike Ross of Arkansas, a leader of conservative and moderate Blue Dog Democrats, said that the changes agreed to by the leadership in the House bill would cut its cost by about $100 billion over 10 years.

While Baucus reported that the Senate Finance Committee's legislation carried a price tag of under $1 trillion, congressional officials said that it included only the cost of the first year of a 10-year, $245 billion program to increase doctor fees under Medicare. House Democrats used a similar sleight of hand, excluding the entire $245 billion when claiming that their proposal would not add to the deficit.

The House deal was worked out in talks that involved not only Democratic leaders but also White House officials eager to advance the bill. Senior congressional aides cast it as a temporary deal, saying that leaders had not committed to support it once the bill advances to the floor of the House in the fall.

As word of the agreement spread, liberals fired back. "We do not support this," said Rep. Lynn Woolsey, D-Calif., a co-chairwoman of the Progressive Caucus. "I think they have no idea how many people are against this. They can't possibly be taking us seriously if they're going to bring this forward."

Plans to convene the Senate Energy and Commerce Committee for a vote slipped until today as leaders sought to allay concerns of liberals.

Whatever the longer-term budgetary or political ramifications, Democrats said that the way is now clear for the committee to approve its portion of the legislation, the last step before it comes to the floor for a vote.

In the Senate, Baucus, Grassley and two other senators from each party have been negotiating for weeks in hopes of agreeing on compromise legislation. Both men face considerable pressure from their respective parties -- Baucus not to stray too far from Democratic objectives, Grassley not to hand the president a political victory.

Republican Sen. Enzi dissented strongly from any impression that a deal was imminent. "There are big issues that haven't been resolved. We haven't even gotten to the little issues," he said. He also minimized the importance of Baucus' claim, saying the Congressional Budget Office has yet to provide a cost estimate "because no precise bill language is available yet."

The pace of decisions appears to have accelerated in recent days, with negotiators all but settling on a tax on high-cost insurance plans to help pay for the bill, as well as a new mechanism designed to curtail the growth of Medicare over the next 10 years and beyond.

More problematic from the Democrats is a tentative agreement to omit a provision in which the government would sell insurance in competition with private industry. In its place, the group is expected to recommend nonprofit cooperatives that could operate at the state, regional or national level.

Nor is any bipartisan recommendation likely to include a requirement for large businesses to offer insurance to their workers. Instead, they would have a choice between offering coverage or paying a portion of any government subsidy that non-insured employees would get.

Like the House bill, the bipartisan proposal under discussion would expand eligibility for Medicaid to 133 percent of the federal poverty level. It provides for federal subsidies for individuals and families up to 300 percent of poverty, less than the 400 percent in the House legislation.

House Republican conservatives, relegated to the sidelines of the debate, unveiled a $700 billion health-care plan with tax credits to help defray the cost of insurance.

Unlike Democratic plans, it would not set up new federally regulated purchasing pools for individuals and small businesses. Instead, it would allow individuals to use the Internet to buy lower-cost coverage if available anywhere in the country. It would provide grants to states to help set up high-risk pools for people with medical problems who are denied coverage by commercial insurers.

Five questions on a health-care overhaul

1. Will there be a public option?
President Obama and many Democrats want a choice for people who aren't satisfied with their private plan. Opponents say that would be government interference with private providers.

2. Will there be an employer mandate?
House and Senate proposals want this, but business groups oppose it. Republicans suggest tax credits for employers who provide insurance.

3. What will reform cost?
Cost estimates for the leading bills in Congress are in the range of $1 trillion over the next 10 years. Obama says that any bill must pay for itself.

4. How will it be paid for?
Obama says that most of the cost can be covered by eliminating waste in the current system.

5. What is the timeline for passage?
Obama said in Raleigh yesterday that he now expects Congress to vote on a health plan in late September or October.