Image: U.S. Speaker of the House Pelosi laughs next to Majority Leader Hoyer and Rep. Miller during a news conference on Capitol Hill.
Yuri Gripas  /  Reuters
U.S. Speaker of the House Nancy Pelosi, center,laughs next to Majority Leader Steny Hoyer, right, and Rep. George Miller, left, during a news conference about the House vote on health care reform on Capitol Hill in Washington on Saturday.
updated 11/8/2009 4:04:29 PM ET 2009-11-08T21:04:29

The glow from a health care triumph faded quickly for President Barack Obama on Sunday as Democrats realized the bill they fought so hard to pass in the House has nowhere to go in the Senate.

Speaking from the Rose Garden about 14 hours after the late Saturday vote, Obama urged senators to be like runners on a relay team and "take the baton and bring this effort to the finish line on behalf of the American people."

The problem is that the Senate won't run with it. The government health insurance plan included in the House bill is unacceptable to a few Democratic moderates who hold the balance of power in the Senate.

If a government plan is part of the deal, "as a matter of conscience, I will not allow this bill to come to a final vote," said Sen. Joe Lieberman, the Connecticut independent whose vote Democrats need to overcome GOP filibusters.

"The House bill is dead on arrival in the Senate," Sen. Lindsey Graham, R-S.C., said dismissively.

No floor debate scheduled
Democrats did not line up to challenge him. Senate Majority Leader Harry Reid, D-Nev., has yet to schedule floor debate and hinted last week that senators may not be able to finish health care this year.

Nonetheless, the House vote provided an important lesson in how to succeed with less-than-perfect party unity, and one that Senate Democrats may be able to adapt. House Democrats overcame their own divisions and broke an impasse that threatened the bill after liberals grudgingly accepted tougher restrictions on abortion funding, as abortion opponents demanded.

In Senate, the stumbling block is the idea of the government competing with private insurers. Liberals may have to swallow hard and accept a deal without a public plan in order to keep the legislation alive. As in the House, the compromise appears to be to the right of the political spectrum.

Republican Sen. Olympia Snowe of Maine, who voted for a version of the Senate bill in committee, has given the Democrats a possible way out. She's proposing to allow a government plan as a last resort, if after a few years premiums keep escalating and local health insurance markets remain in the grip of a few big companies. This is the "trigger" option.

Image: Barack Obama, James Clyburn, Nancy Pelosi
Alex Brandon  /  AP
President Barack Obama talks with House Speaker Nancy Pelosi, D-Calif., and Majority Whip James Clyburn, D-S.C., after meeting with House Democrats about health care on Capitol Hill in Washington Saturday.
That approach appeals to moderates such as Sen. Mary Landrieu, D-La. "If the private market fails to reform, there would be a fallback position," Landrieu said last week. "It should be triggered by choice and affordability, not by political whim."

Lieberman said he opposes the public plan because it could become a huge and costly entitlement program. "I believe the debt can break America and send us into a recession that's worse than the one we're fighting our way out of today," he said.

For now, Reid is trying to find the votes for a different approach: a government plan that states could opt out of.

The Senate is not likely to jump ahead this week on health care. Reid will keep meeting with senators to see if he can work out a political formula that will give him not only the 60 votes needed to begin debate, but the 60 needed to shut off discussion and bring the bill to a final vote.

Costs and coverage estimate
Toward the end of the week, the Congressional Budget Office may report back with a costs and coverage estimate on Reid's bill, which he assembled from legislation passed by the Finance Committee and the Health, Education, Labor and Pensions Committee. The Finance Committee version does not include a government plan.

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Who's who in the health care debateReid has pledged to Obama that he will get the bill done by the end of the year and remains committed to doing that, according to a Senate leadership aide.

Both the House and Senate bills gradually would extend coverage to nearly all Americans by providing government subsidies to help pay premiums. The measures would bar insurers' practices such as charging more to those in poor health or denying them coverage altogether.

All Americans would be required to carry health insurance, either through an employer, a government plan or by purchasing it on their own.

To keep down costs, the government subsidies and consumer protections don't take effect until 2013. During the three-year transition, both bills would provide $5 billion in federal dollars to help get coverage for people with medical problems who are turned down by private insurers.

Both House and Senate would expand significantly the federal-state Medicaid health program for low-income people.

Regulated marketplace
The majority of people with employer-provided health insurance would not see changes. The main beneficiaries would be some 30 million people who have no coverage at work or have to buy it on their own. The legislation would create a federally regulated marketplace where they could shop for coverage.

The are several major differences between the bills.

  • The House would require employers to provide coverage; the Senate does not.
  • The House would pay for the coverage expansion by raising taxes on upper-income earners; the Senate uses a variety of taxes and fees, including a levy on high-cost insurance plans.
  • The House plan costs about $1.2 trillion over 10 years; the Senate version is under $900 billion.

By defusing the abortion issue — at least for now — the House may have helped the long-term prospects for the bill. Catholic bishops also eager to expand society's safety net may yet endorse the final legislation.

Lieberman appeared on "Fox News Sunday," while Graham was CBS' "Face the Nation."

© 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Video: Obama, Senate prep for health fight

  1. Closed captioning of: Obama, Senate prep for health fight

    >>> good evening. a critical milestone was reached overnight in the government's bid to overhaul the health care system . today the president and many fellow democrats are celebrating the passage by the house last night of a health care reform bill. it's to extend coverage of millions uninsured americans , but the battle is far from over with the house on board, all roads to a final bill now lead to the u.s. senate . that guarantees a lot more give-and-take ahead. for more let's go to the white house . mike.

    >> reporter: good evening, lester. it was a long day and victory for the president and democrats, now they press for a final bill agreement with the senate before the end of the year. the president today returning from an overnight trip to camp david . after democrats handed him a heart-fought victory last night in the house.

    >> the yeas are 220 and the nays are 215. the bill is passed.

    >> reporter: in a marathon debate that featured theater.

    >> maddy wants patient choice and doesn't want her mem oes premiums to go up.

    >> mr. speaker i ask unanimous content that my remarks.

    >> i ob --

    >> that insures no mother will have --

    >> but solemn talk of the role of government in health care both for --

    >> when you go to bet at night you wake up knowing in the morning that you have health insurance .

    >> reporter: and against.

    >> i'm not going to put my kids further in debt. i'm not going to dim the lights of freedom for my kids and theirs nor anyone in this country if i can avoid it.

    >> reporter: in the end the bill passed by three votes with 39 democrats, mostly rural conservatives, voting nay. only one republican, representative joseph gau of new orleans was in favor. today in the rose garden the president praised those that stuck with him.

    >> given the heated rhetoric surrounding this legislation, i know this was a courageous vote.

    >> reporter: it would require all americans to get health insurance , require most large businesses to offer a plan to employees, prohibit denial based on pre-existing conditions, extend coverage to an estimated 96% of americans , bar the use of federal funds for abortions, and create a public option. the cost? $1.2 trillion paid for with a surtax on couples making more than a million dollars annually and cuts to the growth of medicare. now it's the senate's turn. joe lieberman threatens prospects for dear to democrats.

    >> if the public option plan is in there, as a matter of conscience, i will not allow this bill to come to a final vote.

    >> reporter: lester, ilts point to point out though the president cleared a big hurdle last night, an even bigger one looms in the senate where there's disagreement on public option and how to pay for all it.

    >> we've asked chief washington correspondent

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