Baucus panel vote today as House, Senate negotiate

WASHINGTON — As a Senate committee today determines the fate of the last of five measures in the landmark effort to overhaul the nation's health-care system, Democrats already are reconciling the various bills.

That exercise includes a new approach to a government insurance plan, missing from the bill sponsored by Senate Finance Committee Chairman Max Baucus of Montana but gaining support with party moderates.

While few, if any, Republicans are expected to support the Baucus bill, not since Theodore Roosevelt proposed universal health care during the 1912 presidential campaign has a legislative effort that would revamp the country's health-care system come this far.

As action shifts to the House and Senate floors in coming weeks, a handful of major issues, and many smaller ones, remain unresolved.

The two chambers disagree on how to pay for the legislation, with the Senate preferring a tax on high-value insurance policies as the main revenue producer, and the House a surcharge on millionaires.

Liberal Democrats want to penalize companies that do not provide coverage to employees; moderate Democrats would take a less punitive approach. And many lawmakers remain unconvinced the policies Congress would require people to buy would be affordable.

But negotiators so far are attempting to smooth out wrinkles before they become major rifts. "We are much closer than we've ever been. I think we're going to make it," said House Energy and Commerce Chairman Henry Waxman, D-Calif., a co-sponsor of the House legislation.

In the Senate, negotiations are shifting from the public forum of the Finance Committee to a more cloistered setting: the office of Majority Leader Harry Reid, D-Nev. After today's vote, Baucus will retreat to Reid's office along with Sen. Chris Dodd, D-Conn., and a handful of top White House officials to meld the finance panel's package with an alternative bill Dodd shepherded through the Senate health committee in July.

Of the three House and two Senate bills, the Finance Committee produced the only one that meets President Obama's targets of providing coverage to the uninsured; barring insurance discrimination based on sex and pre-existing conditions, among other factors — all for less than $900 billion over 10 years, and without adding to the deficit.

Many liberal Democrats, however, view the committee's effort as too meek, something they say is a reflection of three months of negotiations with Republicans and the moderate leanings of many Democrats.

The measure does not mandate that businesses provide coverage to workers. Committee members defeated two versions of a government insurance option. And the bill would tax high-value policies that, to the dismay of many liberal lawmakers, could hit union households.

One proposal attracting considerable attention originated with Delaware Sen. Tom Carper and would allow states to decide whether to create insurance plans or join forces to provide coverage in collaboration with neighboring states.

Other Democrats want to take the state-based approach a step further, creating a national public plan that states could join. Carper, a moderate Democrat, said he is not sure he is prepared to go that far. "I'm just chewing on that one," he said.

Indiana Sen. Evan Bayh, also a moderate Democrat, was bullish on the Carper approach. "I think something like that is likely, and would probably pass muster with moderates," he said. Nebraska Sen. Ben Nelson, another moderate who opposes a public option, has said he, too, likes Carper's idea.

One big question to be answered today with the Finance Committee vote is whether Maine Sen. Olympia Snowe will remain at the table as the sole Republican negotiator involved in shaping the legislation. The moderate is promoting a plan that would create government coverage if private insurers did not offer affordable premiums.

White House officials have indicated support for that approach, and Obama raised the issue during a phone conversation with the senator Thursday, while prodding her about her vote.

"He definitely was fishing," said Snowe, who remains noncommittal.

Snowe — along with many Democrats — also is concerned about whether people will be able to afford the policies they would be required to buy under the Finance Committee bill.

But Democratic aides anticipate near-unanimous support from their members on the panel, which would give them enough votes to pass it without Republican backing.

While an industry-financed report released Monday argued the bill would increase insurance premiums, Democratic aides said they expected lawmakers would view the report as "blatantly false and misleading."

"Instead of creating doubts about our package, I think the report is actually having the opposite effect," one Finance Committee aide said. "I think it has rallied supporters of reform around the package."

Across the Capitol, House Democrats have spent weeks trying to bridge the divide between liberals concerned primarily about securing a public option and rural conservatives who fear doctors and hospitals in their districts would do poorly under that approach.

Connecticut Rep. John Larson, a member of the Democratic leadership, said Democrats are making progress. "I think there's wide support for a robust public option in the caucus, and that's been growing since we got back" to Washington, D.C., after the August recess.