Obama health care effort stumbles

June 19, 2009 8:45:32 AM PDT
President Barack Obama's ambitious effort to remake the nation's health care system was always going to be a marathon. Now the runners seem to have stumbled at the starting line. Sticker shock over cost estimates. Irreconcilable differences between Democrats and Republicans. Tense divisions among Democrats. Creeping delays.

The whole enterprise is "basically a gridlock," Sen. John McCain, R-Ariz., said Friday.

"This is not reform," added McCain, Obama's opponent in last year's presidential election. "This is why we should start over."

But Democrats have another description for the chaotic scene playing out across the Capitol: They call it the legislative process.

"This is just tedious hard work," said Sen. Kent Conrad, D-N.D. "It's just slogging through options."

Amid the heightened anxiety, the shape of the debate is getting a lot clearer.

On one side is the House Democrats' sweeping health care bill, which will be unveiled Friday.

It would require all individuals to obtain health insurance and force employers to offer health care to their workers, with exemptions for small businesses. A new public health insurance plan, strongly opposed by Republicans, would compete with private companies within a new health care purchasing "exchange" where Americans could shop for coverage. Government subsidies would help the poor buy care, according to an outline obtained by The Associated Press.

On the other side is the House Republican plan, which would focus on trying to help small businesses and self-employed individuals find private coverage.

Searching for the elusive middle ground are a small group of senators on the Senate Finance Committee, which had to scale back its initial plan when cost estimates topped $1.6 trillion.

The end result may be a bill that's more affordable but covers fewer of the nearly 50 million uninsured. It's too early to tell what will emerge.

The House Democratic bill, being released at a news conference of the chairmen of the three committees with jurisdiction - Ways and Means; Energy and Commerce; and Education and Labor - was expected to leave out key details of how it would be paid for.

Democrats are considering everything from taxing soda, to raising income taxes on upper income people earning more than $200,000, to a federal sales tax.

On the other side of the Capitol, two Senate committees were going in separate directions on their health care bills. The Health, Education, Labor and Pensions Committee resumed work Friday on an expansive bill reflecting Democratic priorities, while members of the Finance Committee were laboring to produce legislation that could attract Republican support.

To that end, Finance Committee senators were looking at leaving a new public insurance plan out of their bill, instead creating nonprofit co-ops to offer insurance in competition with private companies, according to an outline obtained by the AP. The co-ops could accept federal loans for start-up operations but would have to repay the money.

Struggling to pare their bill from an earlier $1.6 trillion cost estimate to about $1 trillion over 10 years, Finance Committee members pared back proposed federal subsidies for the uninsured. The earlier draft would have helped people making up to four times the federal poverty level, or about $88,000 for a family of four. The new plan: limit insurance subsidies to those making up to $66,000.

Finance Committee Chairman Max Baucus, D-Mont., reviewed the plans behind closed doors Thursday with a group of senators he deemed "the coalition of the willing." Republicans present were top committee Republican Charles Grassley of Iowa, Orrin Hatch of Utah and Olympia Snowe of Maine.

"We're getting closer and closer," Baucus said during a break in the meeting. "There's no doubt in my mind we're going to have a bipartisan bill."

Sen. Christopher Dodd, D-Conn., who is presiding over the Health Committee work session, dismissed bipartisanship as an end in itself.

"My goal here is to write a good bill. My goal is not bipartisanship," said Dodd, who has taken the committee reins in the absence of Sen. Edward M. Kennedy, D-Mass., who's being treated for brain cancer.

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AP Special Correspondent David Espo contributed to this report.

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