Hoping to make history, the Senate set off on its major overhaul of the nation's health care system Wednesday, but its first steps were quickly overtaken by fresh cost concerns and partisan anger.
An ambitious timetable that called for completing committee action in early summer seemed in danger of slipping away.
The Senate Health, Education, Labor and Pensions Committee began work on a bill encompassing President Barack Obama's top legislative priority. It marked the first time since President Bill Clinton's ill-starred attempt in the early 1990s that Congress was tackling such a broad overhaul.
Battle over costs
But the more important Senate Finance Committee announced it would delay action, as senators sought to retool their proposals to slash the cost by more than one-third, from an intial $1.6 trillion over 10 years, to less than $1 trillion. Of the five major panels working on health care, Finance has the best odds of coming up with a bipartisan proposal that could overcome gathering opposition.
Lobbyists representing every nook and cranny of the economy were on high alert — even if they were on their best behavior.
Majority Democrats running the Finance Committee have told lobbyists that their views will be taken into account as long as their groups don't mount public campaigns against the legislation, numerous lobbyists say. So far, health industry groups have not launched aggressive attacks against Democrats' emerging plans.
"We have a lot of sweat equity in this process," said E. Neil Trautwein, chief health care lobbyist for the National Retail Federation, referring to hundreds of hours his group has spent with lawmakers as they prepared legislation. He predicted the bill would prove too costly and force lawmakers to pare it down — or else.
"We need cost relief," he said. "But if comes to the point where we have to cut and run and build a coalition" to oppose the bill, "we'll take that step."
The American Medical Association backed off from a confrontation with the Obama administration over a government-run plan to compete with private insurance, declining to take a firm position at a Chicago meeting Wednesday.
The health committee, which got to work Wednesday, is chaired by Sen. Edward M. Kennedy, D-Mass., and divided along ideological lines. It's expected to produce a bill that heavily reflects the wishes of Democrats, but may not be able to pass the full Senate. Much of the day was taken up with speech-making.
Sen. Christopher Dodd, D-Conn., is overseeing the proceedings in place of Kennedy, who is being treated for brain cancer. "My intention is not to jam anything," Dodd told wary committee Republicans, who say the bill is incomplete, too costly and too one-sided.
"This bill contains policies designed to appease a particular ideology," said Sen. Mike Enzi, R-Wyo., the ranking Republican on the panel.
The complex legislation attempts to slow punishing increases in health care costs, thus freeing up money to cover the nearly 50 million uninsured.
It would boost government subsidies for health insurance, and create new purchasing pools called "exchanges" for individuals and small businesses to buy coverage.
Most people who have employer-provided coverage would be able to keep their plan.
But health care touches every family, and that makes it very difficult to engineer any major changes.
The 1990s Clinton initiative collapsed and the latest attempt has hardly been smooth.
Pressure to approve
Underscoring the difficulty was word Wednesday that the Finance Committee, which had promised a draft as early as this week, has been forced to delay its deliberations, perhaps until after Congress' July 4th recess.
Sen. Kent Conrad, D-N.D., said that proposed changes that sweetened government subsidies to the uninsured had unexpectedly boosted the cost, and now lawmakers must trim back.
Finance Chairman Max Baucus, D-Mont., said the goal is a bill that costs less than $1 trillion over 10 years and is fully paid for. "We'll be ready when we're ready, but we're not there yet."
The panel's top Republican, Chuck Grassley of Iowa, cited three major sticking points: cost, whether to create a new public insurance plan to compete with private insurers and whether to require employers to offer health care or face fines.
The measure before Kennedy's committee would cost about $1 trillion over 10 years, but leave 37 million people uninsured, according to an analysis from the nonpartisan Congressional Budget Office. Parts of the draft bill have yet to be finalized, so its true costs and benefits are not fully understood.
Sen. John McCain, R-Ariz., last year's GOP presidential nominee, questioned how the committee could move ahead on legislation without hard figures on cost.
"How can we possibly, reasonably address this bill ... without accounting how to pay for it?" McCain asked at the start of the committee's session. McCain said it was "a joke if we run through this stack of papers."
Nonetheless, political momentum for remaking the system is the strongest in decades.
"No issue is more of a moral imperative," Dodd said. "In the richest nation on the face of this Earth, you shouldn't have to be well-off to get well."
Big holes remain on the most contentious issues in Kennedy's 600-plus-page bill: a new public insurance plan to compete with the private market, and whether employers must provide health care for their workers.
The committee was scheduled to meet daily through next week. There were 388 amendments to be considered, the vast majority from Republicans.
Cuts in Medicare and Medicaid
Majority Democrats in the House could make their bill public this week, with committee votes after Congress returns from its July 4 recess.
Major cuts in Medicare and Medicaid will pay for some of the new costs but senators disagreed among themselves over whether to tax employer-provided health benefits — something Obama campaigned against. Also elusive was a compromise with Republicans on a new public insurance plan, which the GOP opposes.
Separately, two new health care plans were introduced Wednesday.
House Republicans introduced a proposal that would provide tax credits to help the uninsured buy coverage from private insurers.
And a bipartisan troika of former Senate leaders unveiled a $1.2 trillion plan, fully paid for, that would cover the uninsured. The plan by Democrat Tom Daschle and Republicans Howard Baker and Bob Dole would tax some health care benefits as if they were income. It would leave it up to the states whether or not to create public insurance plans.