Patience running out on health-care overhaul

WASHINGTON — Facing an electorate unhappy with health-care legislation and worried about jobs and financial insecurity, congressional Democrats are under increasing pressure to complete work quickly on their sweeping overhaul and turn to other, more pressing issues.

That may ease the path to a final compromise, as senior Democratic leaders work to reconcile differences between House and Senate versions of the health-care legislation in time to send a bill to President Obama before he delivers his State of the Union address later this month or in early February.

"Health care: Get it over with," is the message that Rep. Marcy Kaptur, D-Ohio, said she got from her economically ravaged district around Toledo over the holiday break. "Do it, but fix what's wrong with the bigger picture here."

Obama will be speaking at a strategy meeting of House Democrats on Thursday, and party leaders have stepped up negotiations in advance of that meeting to resolve major issues.

On Tuesday, Democratic officials said House and Senate negotiators appeared likely to drop a proposed income-tax increase on high-wage earners and possibly jettison a requirement for large businesses to offer coverage to their employees.

Negotiators are considering extending the Medicare payroll tax, which now applies only to income from wages, to cover some of the investment earnings of couples making more than $250,000 a year, and individuals earning above $200,000.

That could make up lost revenue from dropping the high-wage income tax and scaling back a proposed tax on high-value insurance plans, which is strongly opposed by organized labor and House Democrats.

On another high-profile issue, the negotiators are discussing a hybrid of a proposed national insurance exchange contained in the House bill and the state-by-state approach favored by the Senate. House Democrats are pressing for a national system to apply pressure to the insurance industry after their proposal for a new government-run insurance option was ruled out due to opposition from Senate moderates.

These officials also said key lawmakers and the White House were hoping to include more money to protect state governments from the cost of an expansion of the federal-state Medicaid insurance program for the poor. That issue flared after Sen. Ben Nelson, D-Neb., the critical 60th vote for the health-care bill in the Senate, got a deal for the federal government to pay the full cost of Medicaid expansion in his state forever, whereas other states would have to pick up part of the tab after a few years.

The officials spoke on condition of anonymity, saying they were not free to disclose details of the negotiations.

The developments came as the pace of negotiations on health-care legislation quickened with House members returning to Washington on Tuesday from a holiday recess. The White House wants a final bill for Obama to sign in time for his State of the Union address early next month.

Further fueling the push for speedy resolution of the remaining disagreements is sheer weariness. The intense, yearlong battle has left many Democrats with little appetite for another big fight.

"There is definitely fatigue," said Rep. Joe Courtney, D-Conn. "There's skepticism this place can absorb another massive domestic debate."

Prescription-drug

relief urged

A group of House lawmakers and Federal Trade Commission Chairman Jon Leibowitz want Congress to include a provision in the health-care legislation that they say could save American consumers several billion dollars a year on prescription drugs.

The group plans to ask Congress today to block business deals in which they say makers of name-brand drugs directly or indirectly pay generic makers to delay competition from cheaper generic alternatives.

The House bill already includes such a ban. The Congressional Budget Office, considering only federal drug spending, has estimated that the House provision could save the government $1.8 billion in health costs over the next 10 years.

"These are collusive, price-fixing deals," said Rep. Chris Van Hollen, D-Md., who is one of those urging Congress to ban the arrangements. "It means the consumer pays a lot more for their pharmaceuticals."

The Senate version does not include such a prohibition. But a group of nine Democrats, led by Herb Kohl of Wisconsin, signed a letter late last month to the majority leader, Harry Reid, urging that a ban be included in the final legislation.

In recent years, critics say, deals between name-brand makers and generic makers have delayed the introduction of a range of generics including cancer drugs, antidepressants and prescription-strength antacids. The FTC has estimated that such deals currently cost American consumers $3.5 billion a year.

Generics account for only about 22 percent of prescription-drug spending in the United States, although they represent nearly three-quarters of the prescriptions written, according to the research firm IMS Health. That means 78 percent of the nation's drug bill goes toward the 25 percent of prescriptions written for name-brand medicines.

The New York Times