House Democratic leaders Thursday walked their rank-and-file members through last-minute agreements that could move President Barack Obama's overhaul of the nation's health care system a step closer to reality.
Although some issues remained unresolved—including a divisive battle over restricting taxpayer funding of abortion—House Speaker Nancy Pelosi, D-Calif., said: "We have enough to move forward."
White House officials and congressional Democratic leaders met Wednesday evening in Pelosi's office. Aides said they agreed on scaling back a health insurance tax that unions object to, and on gradually closing the Medicare prescription drug coverage gap.
They were not far apart on other major issues, including Medicaid funding for states that already provide above-average benefits, and on improving subsidies that would be available under the plan to help individuals and families pay their premiums.
It will come down to a phenomenal effort by congressional leaders and the White House to win over skittish lawmakers after a year of incendiary debate, even as Obama keeps up campaign-style appearances designed to fire up public support.
At stake is the fate of the president's call to expand health care to some 30 million people who lack insurance and to prohibit insurance company practices such as denial of coverage on the basis of pre-existing medical conditions. Almost every American would be affected by the legislation, which would change the ways people receive and pay for health care, from the most routine checkup to the most expensive, lifesaving treatment.
Democrats still need to see a final cost estimate from the Congressional Budget Office—and want to ensure it stays around $950 billion over 10 years.
The costs of the bill would be covered through a combination of Medicare cuts and tax increases. Among the new levies, the Medicare payroll tax would be applied to the investment earnings of upper-income earners, including proceeds from capital gains. Until now, the tax has solely been levied on wages.
In a bit of bookkeeping, the Congressional Budget Office on Thursday released its final cost estimates for the bill the Senate passed on Christmas Eve—the 10-year, $875 billion plan would reduce the federal deficit and cover 31 million people who'd otherwise be uninsured. The Senate bill is the foundation of the proposal that Obama wants Congress to pass in the next few weeks. But the numbers will change yet again with the new version.
Obama invited members of the Congressional Black Caucus and the Congressional Hispanic Caucus to meet with him Thursday at the White House to discuss the health legislation. The White House also said Obama would travel to northeastern Ohio on Monday for an appearance near the hometown of an uninsured cancer patient named Natoma Canfield, whom the president has made a symbol of the need for reform.
It will be Obama's third event on health care in a week. In St. Charles, Mo., on Wednesday Obama shouted to a crowd: "The time for talk is over. It's time to vote."
House and Senate Democrats are working on a complex rescue mission for the health care legislation, which appeared on the cusp of passage late last year before Senate Republicans gained the strength to sustain a filibuster that could prevent final passage. The White House is pushing for a vote by the House before Obama leaves on a foreign trip at the end of next week.
The current plan is for the House to approve the Senate-passed bill from late last year, despite serious objections to numerous provisions. Both houses then would pass a second bill immediately, making changes in the first measure before both could take effect. The second bill would be debated under rules that bar a filibuster, meaning it could clear by majority vote in the Senate without Democrats needing the 60-vote supermajority now beyond their reach.
Republicans have vowed to do everything they can to thwart the plan, and for the Democrats, some policy questions remain unsettled.
Obama already has moved to eliminate a couple of special deals in the Senate bill that turned off voters when they became public, including extra Medicaid funding for Nebraska -- derided by critics as the "Cornhusker kickback."
Late Wednesday the White House said the president was pushing to strip out a number of deals that remain, possibly including a provision sought by Sen. Max Baucus, D-Mont., providing Medicare coverage for residents of Libby, Mont., who suffer from asbestos-related illnesses because of a now-closed mining operation.
Pelosi and other House Democrats want to include Obama's proposed overhaul of the nation's student loan programs in the second, fix-it health care bill. The measure would require the Education Department to originate all student assistance loans, effectively eliminating a role for banks and other private lenders. That idea has run into opposition from several Senate Democrats.