Date: 07/24/09

U.S. Congress Leaders Struggle with Health Care

By DAVID ESPO and ERICA WERNER
Associated Press Writers

WASHINGTON (AP) Congressional leaders were struggling to ease concerns of moderate to conservative Democrats who have held up progress on health care legislation, a top domestic priority for President Barack Obama.

The congressional leadership all but abandoned a pledge to approve legislation before a monthlong vacation scheduled to begin at the end of next week. The second ranking House Democrat said there was only a small possibility that the legislation would come to a vote before lawmakers' vacation scheduled to begin in a week.

Rep. Steny Hoyer, the majority leader, raised the possibility that the rank-and-file members would be held in session in to the first days of August to vote.

At the White House Obama met with senators in an attempt to speed completion of a bipartisan deal that has been under discussion for weeks.

The flurry of activity occurred as the administration and Democratic leaders fought back against the impression that the legislation was sputtering despite months of effort and negotiation aimed at extending medical coverage to the estimated 50 million Americans who do not have it.

The United States is the only major industrialized nation that lacks a comprehensive health care plan. Most Americans with health insurance receive it through their employers, though those who do not or who are unemployed must either buy costly insurance or pay medical bills out of pocket. The elderly and indigent receive coverage from the government.

Key House Democrats agreed Friday on steps designed to cut the growth of Medicare, the program for the elderly, clearing one of numerous obstacles blocking an early vote on health care legislation. The leader of the House, Speaker Nancy Pelosi, a Democrat, hailed the agreement as a "giant step forward."

Under the agreement, the Institute of Medicine would complete a study by September 2011 recommending changes in the current fee structure.

The administration would have 45 days to submit the report to Congress, and it would go into effect unless Congress blocked it by the end of February 2012.

Separately, lawmakers agreed to call for a second study by the Institute of Medicine to investigate regional differences in payments to Medicare providers, to be implemented in 2014.

Officials said the two steps combined were designed to control the steady increase in Medicare costs, although they provided no immediate estimates of anticipated savings.

Obama has said repeatedly he wants legislation to control the cost of health care as well as to expand insurance coverage to millions who now lack it.

On another front, talks between the leadership and rebellious conservative and moderate Democrats demanding changes in the bill collapsed in acrimony during the day, then were revived with a handshake a few hours later.

The group has enough votes on the Energy and Commerce Committee to prevent the bill's passage there, and the chairman, Rep. Henry Waxman, a Democrat, raised the possibility of simply bypassing the panel and taking the legislation directly to the House floor.

As lawmakers continued to haggle, the White House said Obama will keep working on health care in August even if Congress goes home.

"Nobody in planning meetings decided we should just take August off," said White House press secretary Robert Gibbs. "For a long time we planned to continue the discussion of the issues that are important, be it the economy, health care ... education. That had always in many ways been priced into the scenario."

Obama envisions legislation that would, for the first time, require all Americans to be insured. A new government insurance program would compete with private insurers, and insurance companies would be barred from excluding people with pre-existing conditions. The goals are to hold down costs and extend coverage to most of the 50 million uninsured. The price tag: $1 trillion-plus over a decade.

Obama met Friday morning at the White House with Senate Majority Leader Harry Reid and Finance Committee Chairman Max Baucus, both Democrats. Reid said Thursday that the panel will push to complete a bill before the Senate breaks Aug. 7. Baucus has been negotiating with the panel's Republicans in hopes of producing a bipartisan bill.

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Associated Press Writer Ricardo Alonso-Zaldivar contributed to this report.

Copyright 2009 The Associated Press.