Pelosi lays out possible path for health care

WASHINGTON — Laying out a possible path to passing health-care legislation, House Speaker Nancy Pelosi said Wednesday the House should pass the Senate's version by using a process known as "budget reconciliation" to make changes that House members are demanding.

Because budget reconciliation requires only a simple majority in the Senate, Democrats could circumvent a promised Republican filibuster. "Majority rule, we call it," Pelosi told a group of columnists.

Republicans used the same process to pass former President Bush's tax-cut packages in 2001 and 2003.

Still, House and Senate leaders have not agreed on what changes to make to the Senate health-care bill. House Democrats have demanded elimination of a new tax on high-end "Cadillac" health plans. They also want more subsidies to help low- and moderate-income Americans buy insurance and more aid to states to help expand Medicaid. The Senate bill limits that extra aid to a handful of states, including Nebraska.

Those changes could push the cost of the bill up $300 billion over 10 years to close to $1.2 trillion, according to a senior Senate Democratic aide. That price tag already has been rejected by numerous Senate Democrats as too high.

Numerous procedural challenges would arise, as well, if Democratic leaders used the budget-reconciliation process to modify the Senate health bill. It is unclear, for example, that the Senate could vote on modifications before the House adopted the Senate bill, as many House Democrats want.

Senate Majority Leader Harry Reid, D-Nev., has not publicly endorsed the reconciliation approach, and many rank-and-file Democrats have said they prefer a new, more limited bill that might win some Republican support.

But a growing number of supporters of a health-care overhaul, including doctors, consumer groups and labor unions, have stepped up calls for Democrats to push forward with a more ambitious overhaul. So, too, has the president.