The health care bill headed for a vote in the House this week costs $1.2 trillion or more over a decade, according to numerous Democratic officials and figures contained in an analysis by congressional budget experts, far higher than the $900 billion cited by President Barack Obama as a price tag for his reform plan.
While the Congressional Budget Office has put the cost of expanding coverage in the legislation at roughly $1 trillion, Democrats added billions more on higher spending for public health, a reinsurance program to hold down retiree health costs, payments for preventive services and more.
Many of the additions are designed to improve benefits or ease access to coverage in government programs. The officials who provided overall cost estimates did so on condition of anonymity, saying they were not authorized to discuss them.
House Speaker Nancy Pelosi has referred repeatedly to the bill's net cost of $894 billion over a decade for coverage.
Asked about the higher estimate, Pelosi spokesman Brendan Daly said the measure not only insures 36 million more Americans, it provides critical health insurance reform in a way that is fiscally sound.
"It will not add one dime to the deficit. In fact, the CBO said last week that it will reduce the deficit both in the first 10 years and in the second 10 years," Daly said.
Obama's call for expanded coverage
Democrats have been intent on passing legislation this year to implement Obama's call for expanded coverage for millions, curbs on industry abuses and provisions to slow the rate of growth of health care costs nationally.
"Now, add it all up, and the plan I'm proposing will cost around $900 billion over 10 years," the president said in a nationally televised speech in early September.
Whatever the final cost of legislation, the calendar is working increasingly against the White House and Democrats. While a House vote is possible late this week, Senate Majority Leader Harry Reid, D-Nev., may not be able to begin debate on the issue until the week before Thanksgiving. Additionally, the Republican leader, Sen. Mitch McConnell of Kentucky, has hinted at efforts to extend the debate for weeks if not months, a timetable that could extend into 2010.
One casualty of the time crunch and threatened Republican delaying tactics may be formal House-Senate negotiations on a final compromise. An alternative is a less formal hurry-up final negotiation involving the White House and senior Democrats.
Pelosi and her lieutenants worked on last-minute changes in the measure to ease concerns among opponents of abortion and a contentious provision relating to illegal immigrants. Conservative Democrats have expressed concern about the cost of the bill, and an evening closed-door meeting gave Pelosi and her lieutenants their first chance to hear their response.
The bill includes an option for a government-run health plan.
The leadership can afford more than two dozen defections and still be assured of the votes to prevail on the bill, one of the most sweeping measures in recent years.
‘We believe it is the wrong prescription’
Republicans put the cost of the bill at nearly $1.3 trillion.
"Our goal is to make it as difficult as possible for" Democrats to pass it, House Republican leader John Boehner, R-Ohio, said at a news conference. "We believe it is the wrong prescription."
One day after announcing Republicans would have an alternative measure, Boehner offered few details. He said it would omit one of the central provisions in Democratic bills — a ban on the insurance industry's practice of denying coverage on the basis of pre-existing medical conditions. Instead, he said the Republicans would encourage creation of insurance pools for high-risk individuals and take other steps to ease their access to coverage.
Rep. Mike Pence, R-Ind., the third-ranking leader, said that Democrats looked at their bill as a way to advance universal coverage. In contrast, he said, Republicans "believe the real issue back home is cost" of insurance, and said their alternative would be designed to tackle it.
Democrats have made elimination of the industry's practice a linchpin of their drive to overhaul the health care system. The industry has said it would not fight the change, and an accompanying restriction on its ability to charge higher premiums for certain groups, as the legislation includes a requirement for individuals to purchase insurance. Lacking that, the industry says millions of relatively healthy individuals would refuse to pay for coverage until they became sick, and the cost of premiums would rise sharply for everyone else.
GOP opposes mandates
Republicans oppose any government requirements for individuals to purchase insurance or for businesses to provide coverage.
The Congressional Budget Office is seen by lawmakers as the arbiter of claims about the costs and effects of proposed legislation, and the agency has been under intense pressure in recent weeks to compete assessments on several bills circulating in House and Senate.
In a letter last week, the agency's director, Dr. Douglas Elmendorf, said the net cost of expanding coverage in the House measure was estimated at $894 billion over 10 years, a figure reflecting a gross total of $1 trillion in federal subsidies as well as other spending.
The letter contained no similar assessment for the balance of the legislation and it was not clear when or whether one would be forthcoming.
In a letter last week to Sen. Max Baucus, D-Mont., on the general subject of health care, Elmendorf cautioned that some provisions in legislation have elements that raise costs and elements that lower costs.
"Tabulating all of the aspects of the proposal that would, in isolation, increase federal outlays would be complicated and would require somewhat arbitrary judgments" about calculating overall costs, Elmendorf said.