Image: Demonstration
JEWEL SAMAD  /  AFP/Getty Images
Demonstrators display placards supporting President Barack Obama's proposed health care overhaul during a demonstration in Washington on March 9.
updated 3/10/2010 7:15:05 PM ET 2010-03-11T00:15:05

Democrats claimed momentum Wednesday in their drive to enact the sweeping health care legislation sought by President Barack Obama, citing near agreement on crucial issues despite persistent Republican efforts to knock them offstride.

Obama himself, rallying support outside Washington for the second time this week, shouted to a crowd in Missouri, "The time for talk is over. It's time to vote."

At the Capitol, House Speaker Nancy Pelosi said that after days of secretive talks, key Democrats were "pretty close" to accord on additional subsidies to help lower-income families purchase insurance, more aid for states under the Medicaid program for low-income Americans and additional help for seniors who face a coverage gap under current Medicare drug plans.

Pelosi, D-Calif., offered no details, and other officials cautioned that any final deal would hinge on cost estimates under preparation at the Congressional Budget Office.

Several officials in both houses also said Democrats were likely to impose a new payroll tax of as much as 2.9 percent on investment and dividend income earned by wealthy taxpayers. In addition, any legislation is expected to include a tax on high-cost insurance plans, along the lines of an agreement the White House negotiated late last year with organized labor.

Fate of health care reform at stake
At stake is the fate of Obama's call to expand health care to some 30 million people who lack insurance and to ban insurance company practices such as denial of coverage on the basis of pre-existing medical conditions. He also hopes to begin to reduce the rise in the cost of health care nationally.

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.

Pelosi made her comments as Obama followed his campaign-reminiscent Pennsylvania trip of Monday with an appearance near St. Louis, pushing hard in the home stretch of the marathon battle to pass his signature domestic legislation.

"The time for talk is over. It's time to vote. It's time to vote. Tired of talking about it," he told the crowd.

With his shirt sleeves rolled up, Obama denounced waste and inefficiency in the government's health care system, and he announced that he had signed an executive order directing Cabinet secretaries and agency heads to intensify their use of private auditors to root out fraud.

Video: Health care debate moved to Midwest House and Senate Democrats are working on a complex rescue mission for the health care legislation that appeared on the cusp of passage late last year, before Senate Republicans gained the strength to sustain a filibuster that could prevent final passage.

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The current hope of the White House and Democratic leaders is for the House to approve the Senate-passed bill from late last year, despite serious objections to numerous provisions. Both houses would then 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 and without Democrats needing to amass a 60-vote supermajority that is beyond their reach.

GOP vows to thwart the plan
Republicans have vowed to do everything they can to thwart the plan, and to go after Democratic supporters in next fall's midterm elections. In the Senate, the GOP rank and file issued a letter pledging to strip out any provision that does not adhere scrupulously to complex rules.

In addition, GOP leaders sought to stoke the fears of House Democrats who worried that the Senate would not approve the second bill. Even so, Sen. Jon Kyl, R-Ariz., the second ranking Senate GOP leader, conceded, "We can't delay a bill for months. We might delay it for a few hours."

Congressional Democrats and the White House are grappling with other issues as they maneuver toward a final vote.

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 Department of Education to originate all student assistance loans, effectively eliminating a role for banks and private lenders.

Idea has run into opposition
That idea has run into opposition from several Senate Democrats, and while officials said the controversy was debated at length in a closed-door meeting Tuesday night, no decision was made.

Additionally, some House Democrats are hoping to avoid a straightforward vote on the Senate-passed health care bill. Instead, they want a procedural vote that would simply declare the measure to have passed at the moment the Senate cleared the fix-it bill.

Rep. Louise Slaughter, D-N.Y., chairwoman of the House Rules Committee, said that approach was under discussion. But other officials said no decisions had been made.

To the annoyance of some Democrats, the White House is pushing for a vote by the House before Obama leaves on a foreign trip at the end of next week.

Demand for additional Medicaid funds
Several officials said one of the thorniest issues to be resolved in the House-Senate negotiations was a demand from a dozen states for additional funds under Medicaid.

These states, New York, Pennsylvania and Massachusetts among them, already provide coverage under the low-income program for the poor that other states do not but would be required to if the legislation passes. The 12 are concerned that they will effectively be penalized for having been more generous than the rest of the country.

The legislation that passed the Senate late last year included a new Medicare payroll tax of 2.3 percent on wages for upper-income Americans. The White House wants to extend the tax to dividends and interest, at a higher rate of 2.9 percent.

Much of the proceeds would offset changes in an excise tax the Senate approved on high-cost insurance plans. Responding to criticism from labor leaders, the White House agreed over the winter to scale it back significantly. Officials said the revised proposal would raise about $120 billion less over a decade than the measure the Senate passed.

Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Video: Biden ‘hopeful’ ahead of health deadline

  1. Closed captioning of: Biden ‘hopeful’ ahead of health deadline

    >>> that one. now my interview with vice president biden on the white house 's last big push to pass health care reform . here we are in the holy land mr. vice president. the president of the united states , your boss, has set a deadline for action on the health care bill. it is a deadline -- you are laughing but it is real. he wants this bill out of the house by the end of next week.

    >> so do i?

    >> how are you going to do it.

    >> i feel confident the speaker can get these votes. everybody talks about the extraordinary process. this bill passed the united states senate with 60 votes.

    >> yeah.

    >> 60 votes. to ask a majority of the members of the house to pass it and have that be extra judicial or extra legislative, this has been blown out of proportion. it will be reconciled. this so-called reconciliation process, only in washington is the world reconciliation mean war.

    >> so you're confident. what would be the adjective of going into the next week, this last hurrah on this bill? the joe biden vice presidential view.

    >> i'm hopeful.

    >> do you think he has succeeded, do you think the president and his people, including you, have done a good job explaining this bill to the american people . if so, here is the hook, why are they so resistant to it?

    >> because it is real complicated, chris. incredibly complicated. explaining the mechanism to a way everybody can buy into an insurance pool. this is a complicated system. one of the thing the republicans did very well they spent the month of last august making a very strong rhetorical case against it. they talk about death panels. they talk about all these things that are absolutely ridiculous. when you ask people how they feel about the bill, taking the constituent parts, they like it. this is complicated stuff.

    >> remember the loaves and the fishes?

    >> i do.

    >> a lot of people can't forget how you insured 30 million more people, a lot of liberals -- i support that, i like every progressive says let's get 30 million. how do you do that and lower the overall cost of health care .

    >> i'll tell you how you do it. when you have everybody in the game those 30 million people are not showing up at an emergency room without any insurance getting care and you being charged for it. it costs you about a thousand bucks a year.

    >> now they have a doctor, primary care , dentists and all the other costs of health care .

    >> well, what that does is it also saves billions of dollars in preventive care . there is overwhelming evidence if people didn't wait to the last minute to deal with the crisis on their hands in an emergency room it would cost a whole lot less money to maintain their health. so it is a little bit -- let me give you one that confuses the heck out of people. how are hospitals going to do this? we are paying hospitals an extra bonus out of medicare to take care of people who don't have insurance. if everybody walking in the door has insurance we don't have to pay them the bonus and save $100 billion.

    >> do you think you have done a good job of selling this?

    >> no.

    >> why?

    >> because it is complicated.

    >> all i do is read stories about rahm emanuel is up, he's down, he has friends, he doesn't have friends. why are there so many stories looking under the hood of the white house ?

    >> because for the first year you couldn't find any problems. this is the first administration that eight presidents i have been you don't have stories about the fundamental division in the white house and among the cabinet. they couldn't find it there, go inside. go inside. look, this is great theater in washington.

    >> you want great theater. eric massa is leaving the house. he says that rahm emanuel went up to him in the gym when he was stark naked and said, why are you voting for the health care bill. is the guy too tough?

    >> no. he is not too tough.

    >> what do you make of that escapade?

    >> first of all, i have no idea if that happened. the guy who said it happened gave three different reasons why he is leaving the house. let me tell you rahm emanuel is smart, he is tough, he is fair. he serves the president very, very well.

    >> let's go to the question i know you care about. you are pro-choice on abortion rights , ultimately it is up to the woman, but you are on the hyde amendment . a lot of people fit that description. most people who are pro-choice are against funding. nancy pelosi made a strong statement there is no federal money for abortion. are you confident?

    >> i am confident. when that comes to a vote on the floor of the health care bill i am confident that it will be absolutely prohibitive to use federal funding to provide for abortion.

    >> here is a tough question. the white house staff has done a good job selling the president's programs?

    >> i think it's done a good job.

    >> here is the question. how come the republicans bashed the brains into this president saying he did the bailout bill when bush did the bailout? why do they confuse the bailout bill with the stimulus bill and get away with it. they keep conflating the bailout bush did with the job stimulus bill and the democrats get blamed.

    >> what i keep saying in the white house . patience. have a little patience here. things are beginning to turn around. they are beginning to turn around not only in fact in the economy, but in figuring out the republicans are for nothing. what are they for? what have they offered? it is true that when you see in the news x hundred billion dollars for banks no matter who started it, it is awful hard for the guy sitting at the kitchen table in north philly saying, hey, man, i don't have a job and they are giving all this noun banks. this is not a hard thick to sell until we start seeing 100,000 created, 200,000 jobs create.

    >> as we say in northeast philly , shalom.

    >> that is not what you say in northeast philly .

    >>> he condemned israel's decision to build housing units. it was a big-time slap in the face to the white house and put a dark cloud over biden's trip. you are watching "hardball" from jerusalem only

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