President Barack Obama and top Democrats began trying to shape a final health overhaul bill on Wednesday in a White House meeting that underscored their desire to strike a quick deal on the administration's top domestic priority.
The president was meeting with House Speaker Nancy Pelosi, D-Calif., Senate Majority Leader Harry Reid, D-Nev., and other Democratic leaders to narrow differences between the House and Senate over the massive legislation. Congressional aides said the session was expected to last hours -- the latest indications that Democrats want the health drive, which began when Obama took office a year ago, to bear fruit before his State of the Union address, perhaps in early February.
Among the pressures they faced was a special election next Tuesday in Massachusetts to replace the late Democratic Sen. Edward Kennedy -- an unexpectedly close race that could cost Democrats the pivotal 60th vote they need to push the measure through the Senate.
With polls showing public support for Obama's health care effort slowly drooping, House Republican leader John Boehner of Ohio told GOP lawmakers that they could still sink the legislation. Republican leaders said they believed dozens of House Democrats who supported the initial bill might feel pressure to abandon the final version because of potential changes in provisions on abortion, Medicare cuts and federal Medicaid aid to states.
"The bottom line is, I believe we can beat this bill," Boehner told House Republicans in a closed-door meeting, according to his aides. "The American people are with us."
Lower-level negotiators from the White House and the two chambers have already been holding closed-door meetings and trying to make decisions. They seem likely to abandon a House-approved surtax on the wealthy even as they consider extending the Medicare payroll tax to investment income of high earners, Democratic officials said.
"I have so much faith in the president of the United States and his ability to be persuasive," House Ways and Means Committee Chairman Charles Rangel, D-N.Y., said Tuesday.
On another major difference between the two chambers, bargainers are considering a combination of the national insurance exchange the House approved and the Senate's preference for letting each state establish its own exchange, Democratic officials said. The exchanges in effect would be marketplaces where consumers could compare competing health care policies before purchasing them.
The officials spoke on condition of anonymity, saying they were not free to disclose details of the negotiations.
The House returned from its year-end break on Tuesday, and Democrats met immediately to get an update from their leaders. Lawmakers left that session expressing a mix of resolve to craft a compromise and defiance of Senate Democrats, who passed their version of the bill on Christmas Eve without a vote to spare. House passage in November was also a nail-biter, 220-215.
"A lot of people think we have a gun to our head and don't like it very much," said Rep. Anthony Weiner, D-N.Y., referring to senators' insistence that their bill can't be changed much without risking anew the 60 votes they need for passage. He said there was a "squeal like pigs" coming from the Senate about the difficulties of retaining those 60 votes.
After letting Congress provide most of the legislation's details last year, Obama in recent days has spelled out his preferences on two measures aimed at curbing health care costs. He has told lawmakers he wants at least a pared-down tax on high-cost insurance plans, which is opposed by labor and House Democrats, and favors a commission with power to order cuts to Medicare spending in some circumstances.
Among the remaining House-Senate disputes are restrictions each chamber approved on federal financing of abortions. The House voted for the stricter version of the two, and some anti-abortion and abortion-rights Democrats have threatened to abandon the final package unless the language is to their liking.
Rep. Bart Stupak, D-Mich., who led the successful fight last month for the House bill's tight anti-abortion language, said in an interview Tuesday that he has had two broad discussions with House leaders about that issue. He said he believes his provision -- or something very close to it -- has popular support but did not rule out striking a compromise.
"How we work that out I guess remains to be seen, but I think in the long run it can be worked out," he said.
In dealing the remaining issues described by Democratic officials, negotiators:
--Are considering extending the Medicare payroll tax, which now applies only to wages, to some of the investment earnings of couples making more than $250,000 a year and individuals earning more than $200,000.
--Seem likely to drop the House-passed income tax boost on individuals making more than $500,000 a year and couples making over $1 million.
--Might jettison a House-approved requirement for large businesses to provide health coverage for their workers.
--Could include more federal money to help states pay for an expansion of the federal-state Medicaid insurance program for the poor. That issue flared after Sen. Ben Nelson, D-Neb., the critical 60th vote for the health care bill in the Senate, got a deal for the federal government to pay the full cost of Medicaid expansion in his state permanently, while other states would have to pick up part of the tab after a few years.