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House, Senate leaders
agree on most of health bill

The plan would require Americans to get insurance, and insurers would be required to accept all who seek coverage.

By James Rowley and Laura Litvan, Bloomberg News

WASHINGTON — House and Senate leaders have agreed on most elements of legislation needed to push forward President Barack Obama's proposed overhaul of the U.S. health-care system, top House Democrats said.

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Democrats are calling for the biggest changes to the medical system since the Medicare health program for the elderly was created in 1965.

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The leaders are proposing changes to a 10-year, $875 billion Senate bill in a bid to make it acceptable to House Democrats. The Senate would then pass the changes under a budget procedure known as reconciliation, which requires only a majority vote in the Democratic-controlled chamber.

Democrats are calling for the biggest changes to the medical system since the Medicare health program for the elderly was created in 1965. Their plan would require Americans to get insurance, with new purchasing exchanges and government aid to help. Insurers would be required to accept all who seek coverage.

The leaders presented the outlines of the plan, opposed by Republicans, to House Democrats today. There's agreement on most of the main issues, said Rep. Henry Waxman, D-Calif., who's helping oversee the health-care effort.

"The decisions are made, the choice has to be made" by lawmakers, House Speaker Nancy Pelosi, D-Calif., told reporters.
Senate Majority Leader Harry Reid, D-Nev., in a letter to his Republican counterpart, said today that Democrats plan to use reconciliation to pass final health-care legislation.

"Many Republicans now are demanding that we simply ignore the progress we've made," Reid told Senate Minority Leader Mitch McConnell, R-Ky. "We will not. We will finish the job," adding that "we plan to use the regular budget-reconciliation process."

Obama is pushing Congress to act before lawmakers leave for a two-week recess on March 26. Pelosi said the vote "is not something we are going to drag out."

Pelosi said the legislation will eliminate 80 percent of an excise tax on high-priced insurance plans in the Senate measure and replace the lost revenue with a Medicare payroll tax on unearned income. It will increase Medicare prescription-drug benefits to eliminate a gap in coverage for seniors, she said.

Still unresolved are the amount of subsidies to help low-income Americans purchase insurance and how much extra help to give states such as New York that offer more generous Medicaid benefits, said a House Democratic leadership aide who spoke on condition of anonymity.

Sen. Judd Gregg, R-N.H., charged with leading his party's floor fight against the legislation, said today the Democrats may have the edge in passing the measure.

"You've got creative minds on the other side who are totally dedicated to passing this bill, and the president's obviously invested at a level that is uniquely intense," Gregg said at a National Press Club event sponsored by Health Affairs magazine. "We're still swimming upstream, I presume."

Timing may be an issue. Gregg said he believes the Senate parliamentarian will rule that Obama must first sign the Senate bill into law before lawmakers can take up reconciliation.

Republicans have other ways to prevent Democrats from triumphing as well, Gregg said.

They can put forth "massive amounts" of amendments on issues ranging from gun control to immigration to abortion policy, Gregg said. What passes in the Senate might be entirely different than what the House passes, and will force moderate Democrats to take some tough votes, he said.

Republicans also are prepared to stick together on votes challenging the use of reconciliation on items that might increase the U.S. budget deficit — votes that may force some provisions to be removed.

"This is going to be a pretty heavy lift to do it this way," Gregg said.

The leaders haven't yet decided whether to include House legislation to revamp the college student loan program, Waxman said. The House-passed measure would expand a government student lending program to eliminate the role of private lenders making federally-guaranteed loans.

The Senate has resisted the measure, which is opposed by several Democrats whose states are home to private lenders. The White House is also asking Democrats to take out provisions in the Senate bill such as one that provided extra aid to Nebraska to cope with increased Medicaid funding.

"We've made it clear to the Senate that the president's position is that the final bill shouldn't include any earmarks or provisions that would favor a single state or district," said White House spokesman Reid Cherlin.

Democrats also have to resolve a dispute over how to prevent federal funds from being used for abortions. Rep. Bart Stupak, D-Mich., who has said about a dozen fellow anti-abortion Democrats might flip their votes to oppose the health-care bill, said he's talking with House leaders."There are a number of people who share his views who are voting for the bill," Waxman said.

White House officials said the reconciliation bill will be about 100 pages long, Rep. Anthony Weiner, D-N.Y., said after today's meeting. The absence of details troubled some lawmakers, he said.

"Members need to see a product," Weiner said.