Prodded by President Barack Obama, senior Democratic lawmakers held lengthy talks at the White House on Wednesday as they searched for a final compromise on overdue health care legislation.
Several officials said numerous details remained to be settled, including the size of the subsidies that would go to lower-income Americans who require help in affording insurance.
It was not clear what progress, if any, the day's negotiations yielded. "I don't know whether they'll get through discussing all that they need to today," said White House press secretary Robert Gibbs.
The House and Senate have passed different versions of the measure, which Obama wants to expand health coverage to millions who lack it, end insurance company practices such as denying coverage on the basis of pre-existing medical conditions and slow the rate of growth of medical costs overall.
As if to illustrate the disagreement among Democrats, the House's senior lawmaker — Rep. John Dingell, D-Mich. — said a Senate-approved tax on expensive insurance plans "seems kind of dumb to me." Labor leaders and House Democrats have said the plan would hit union members and many middle-class families.
But Obama favors it as a way of reining in the skyrocketing cost of health care, and the Senate included the proposal in its bill.
The unusually long meeting underscored the sense of urgency within the administration about completing work on business left over from 2009.
Lawmakers customarily attend meetings at the White House that last an hour or so. In this case, administration aides said a session that convened in midmorning was still going three hours later, with the president shuttling in and out as he attended to other business. Senior congressional staff members were also in attendance, an indication that the goal was to resolve differences and reduce them to writing, rather than merely discuss them and leave the details to later.
After largely deferring to lawmakers on details of the legislation, Obama has weighed in more forcefully in recent days, and the meeting at the White House appeared to be part of that trend.
Officials have said in recent days that numerous major issues were unresolved, some but not all awaiting a decision on how much money was available to defray the cost of health coverage for lower-income families who lack it.
The House approved an income tax surcharge on the wealthy, but that is expected to be jettisoned. Unclear was the fate of the proposed tax on high-cost insurance plans, and the details of a Senate-approved payroll tax increase on the wealthy.
There were differences, as well, on the details of a proposed new federally regulated system where consumers could shop for private insurance coverage. The House wants a single national exchange as a way of toughening review of insurance company practices. The Senate bill calls for a state-by-state approach.
One large issue is scarcely in doubt. A House-passed proposal for a government-backed insurance option was widely viewed as dead, the victim of opposition from moderate Senate Democrats whose votes are essential to the bill's passage.
The lawmakers went to the White House as Democrats considered the once-unthinkable — that a special election in Massachusetts could result in a Republican victory that would effectively doom the health care legislation.
The state is the most solidly Democratic in the country, and the winner of the race will succeed the late Sen. Edward M. Kennedy, a career-long champion of universal health care. Despite their built-in advantages, Democrats betrayed numerous signs of nervousness that their candidate, Martha Coakley, could not take victory for granted.
She has pledged to vote for the health care bill if elected. Her opponent, Scott Brown, has vowed to become the 41st Republican opponent, enough to uphold a filibuster that would send the legislation to defeat.
With polls showing public support for Obama's health care effort slowly dropping, House Republican leader John Boehner of Ohio told GOP lawmakers that they could still sink the legislation. Republican leaders said they believed dozens of House Democrats who supported the initial bill might feel pressure to abandon the final version because of potential changes in provisions on abortion, Medicare cuts and federal Medicaid aid to states.
"The bottom line is, I believe we can beat this bill," Boehner told House Republicans in a closed-door meeting, according to his aides. "The American people are with us."