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House Democrats struggle on health care

/ Source: The Associated Press

Top House Democrats sought to minimize the impact of a near-certain missed deadline for health care legislation on Tuesday as the leadership struggled to ease the concerns of rank-and-file critics.

"I'm disappointed of course because I really hoped that we could have gotten a bill out of here by the end of this month," said Rep. Charles Rangel, D-N.Y., and chairman of one of the three committees at work on the measure.

"The issue is critical. Whether we do it at the end of July or not, I don't think that's critical except the perception in terms that the Congress didn't respond to the request of the president."

President Barack Obama had asked Congress to advance legislation through both houses by the time lawmakers leave on a monthlong summer vacation, a plea that now appears unlikely to be met.

Obama has worked intensively to reassure the public about his health care proposals at a time when Republicans have stepped up their criticism and polls suggest a leveling in public support. Making his pitch to a crucial constituency, Obama went to the headquarters of AARP, the huge advocacy group for seniors, for a town-hall style event.

"Sometimes I get a little frustrated because this is one of those situations where it is so obvious that the system we have isn't working well for too many people and that we could just be doing better," Obama said to close the hourlong question-and-answer session. "We got to have the courage to be willing to change things."

The president looked to ease seniors' concerns about changes to care, costs and other issues.

"The costs of doing nothing are trillions of dollars in costs over the next couple of decades — trillions, not billions — but trillions of dollars in costs without anybody getting any better care," Obama said. "Now, here's the problem, that in order for us to save money, in some cases, we've got to spend some money up front."

Among the problems facing Speaker Nancy Pelosi and the House leadership is a rebellious group of conservative and moderate Democrats demanding changes in legislation as the price for voting it out of the House Energy and Commerce Committee.

The fiscally conservative Blue Dogs were at odds with the leadership over setting rates for the payments to doctors and other health care providers under a proposed government-run health plan that would compete with private insurance. The House bill models the payments based on Medicare, but Blue Dogs want a negotiated rate similar to private insurance.

"We're not ready to support a bill yet," said Rep. Baron Hill, D-Ind., a member of the Blue Dog group, who added: "We'll get there. We are going to pass a health care bill, whether it's now or in the fall remains to be seen."

Without the backing of the 52-member Blue Dogs, it would be difficult for Democratic leaders to pass a bill, especially since no Republican supports the legislation.

After weeks of secretive talks, three Democrats and three Republicans on the Senate Finance Committee were edging closer to a compromise that excludes a requirement many congressional Democrats seek for large businesses to offer coverage to their workers. Nor would there be a provision for a government insurance option, despite Obama's support for such a plan, officials said.

The Finance senators were considering a tax of as much as 35 percent on very high-cost insurance policies, part of an attempt to rein in rapid escalation of costs. Also likely to be included in any deal was creation of a commission charged with slowing the growth of Medicare.

Obama has outlined two broad goals for legislation he is struggling to win from Congress: expansion of health insurance coverage to millions who lack it, and controlling costs.

The president's top domestic priority has suffered numerous setbacks in recent weeks and a Senate vote has been postponed until September. Administration and Democratic leaders hope to show significant progress before lawmakers begin their monthlong August recess.

In the Senate, officials speaking on condition of anonymity because they were not authorized to discuss private negotiations said any legislation that emerges from the talks is expected to provide for a nonprofit cooperative to sell insurance in competition with private industry, rather than giving the federal government a role in the marketplace.

Obama and numerous Democrats in Congress have called for a government option to provide competition to private companies and hold down costs, and the House bill includes one — another concern for the Blue Dogs.

Officials also said a bipartisan compromise in the Senate would not subject large companies to a penalty if they declined to offer coverage to their workers. Instead, these businesses would be required to reimburse the government for part or all of any federal subsidies designed to help lower-income employees obtain insurance on their own.

The legislation in the House includes both a penalty and a requirement for large companies to share in the cost of covering employees.