Clock Ticking on Democrats' Health Care Reform

Time growing short, Democratic leaders in the House and Senate still face key decisions if they are to achieve President Barack Obama's goal of passing legislation to remake the nation's health care system by year's end.

Mark Lennihan / AP

In the House, that means setting conditions under which the federal government would sell coverage in competition with private industry. The remaining disagreements among rank and file Democrats revolve largely around the fees to be paid doctors and hospitals under the plan, and whether they should be dictated by federal officials or established in negotiations.

And in the Senate, it means deciding whether legislation will give the government a role in the marketplace at all, and if so, what rights individual states would have in deciding whether to participate.

Both Speaker Nancy Pelosi and Senate Majority Leader Harry Reid are expected to make their decisions this week in hopes the long-delayed bills can come to a vote in early November.

Numerous other questions remain unanswered before that can happen, particularly in the Senate, where Reid, two committee chairmen and senior White House officials are trying to craft legislation that can achieve Obama's objectives and command the 60 votes needed to overcome any Republican filibuster.

Officials familiar with the talks say businesses would not be required to provide health insurance under legislation being readied. But large companies would owe significant penalties if any worker needed government subsidies to buy coverage on their own.

For businesses with more than 50 employees, the fee could be as high as $750 multiplied by the total size of the work force if only a few workers needed federal aid, these officials said. That is a more stringent penalty than in a bill that recently cleared the Senate Finance Committee, which said companies should face penalties on a per-employee basis.

These officials also said individuals would generally be required to purchase affordable insurance if it were available, and face penalties if they defied the requirement.

The officials spoke on condition of anonymity, saying they were not authorized to discuss the private negotiations involving key Senate Democrats and the White House. They also stressed that no final decisions have been made on the details of the measure.

In general, the bills taking shape in both houses are intended to expand coverage to millions who lack it, ban insurance industry practices such as denial of coverage for pre-existing medical conditions and slow the growth in medical spending nationally.

They would create a new federally regulated marketplace, termed an exchange, where individuals and families could purchase insurance sold by private industry. Federal subsidies would be available to help those at lower incomes afford the cost.

Subsidies would also be available to smaller businesses as an incentive for them to provide insurance.

Obama has set a spending limit of roughly $900 billion over a decade for the legislation, but has already agreed not to count more than $200 billion to raise fees for doctors treating Medicare patients over the next 10 years.

He also appears willing to bow to the wishes of House Democrats, whose bill is expected to total roughly $1 trillion. Democrats argue some of that spending shouldn't be counted against Obama's total because it doesn't deal directly with the cost of providing coverage.

It covers items such as improved benefits for Medicare and Medicaid, as well as money spent on disease prevention programs.

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