Democrats inch ahead on health care

WASHINGTON — Congressional Democratic leaders worked throughout the day Thursday to settle lingering intraparty disagreements over abortion, federal insurance subsidies and other issues — seeking agreement on the finishing touches for a health-care package they hope to send President Obama by the end of the month.

But senior Democrats acknowledged they were not ready to move forward and could miss a tentative deadline for a first vote next week.

"It's not done yet, and that's an understatement," said Senate Majority Leader Harry Reid, D-Nev.

House Speaker Nancy Pelosi, D-Calif., said she wanted to give her members "at least one week" to review the package before they vote. "It may take longer," she said after House Democrats met for two hours with Nancy-Ann DeParle, head of the White House Office of Health Reform.

Democratic leaders believe the House will have to vote first on the health-care bill approved by the Senate last year without trying to change it. They then plan to use a process known as budget reconciliation to push a package of changes sought by House Democrats through the House and Senate.

Because budget-reconciliation measures cannot be filibustered under Senate rules, Democrats could move the package with 51 votes instead of the 60 usually needed to cut off debate.

Republican and Democratic lawmakers quarreled Thursday over whether Obama must sign the Senate bill into law before Congress can make changes.

Republicans plan to pounce on Democrats the instant the Senate bill becomes law, and House and Senate parliamentarians eventually may have to determine the allowable sequence of actions.

Democrats in the House and Senate largely have agreed on the basic shape of the reconciliation package, which parallels the health-care blueprint outlined by Obama last month.

Many Democrats are eager to finish the debate. "I think everybody understands we need to move on. We've got other things we've got to do," said Rep. Gerry Connolly, D-Va., president of the Democratic freshman class in the House. "This is our last best chance."

The package is expected to boost subsidies for low- and moderate-income Americans who would be required to buy health insurance. It would scale back a new tax on high-end "Cadillac" health plans, a key part of the Senate bill.

It would phase out a gap in Medicare's drug coverage and provide additional aid to states to help them expand Medicaid programs for the poor, while eliminating special assistance for Nebraska that was included in the Senate bill but stirred a storm of criticism.

But Democratic officials still were trying to assess the final cost of the changes, which are being analyzed by the nonpartisan Congressional Budget Office.

And tensions remain around some issues such as abortion, with a group of conservative House Democrats threatening to oppose the health-care legislation unless party leaders take steps to toughen restrictions on federal funding for insurance coverage of the procedure. Democratic leaders believe budget rules preclude them from including abortion language in the reconciliation package.

Some Democrats are pushing to include an unrelated measure that would limit the role of private banks in the federal student-loan program. Some Democrats back the idea because they fear the initiative — a key part of Obama's education agenda — will be slowed or killed by opposition from banks who stand to lose generous federal subsidies.

Information from The Associated Press is included in this report.