Health care legislation back behind closed doors

Health care talks slip back behind closed doors Wednesday as Senate leaders start trying to merge two very different bills into a new version that can get the 60 votes needed to guarantee its passage.

All eyes are on Senate Majority Leader Harry Reid of Nevada, who has said he wants to complete the wedding quickly and get historic health care overhaul legislation onto the floor the week after next.

Both bills were written by Democrats, but that's not going to make it easier for Reid. They share a common goal, which is to provide all Americans with access to affordable health insurance, but they differ on how to accomplish it.

The Finance Committee bill that was approved Tuesday has no government-sponsored insurance plan and no requirement on employers that they must offer coverage. It relies instead on a requirement that all Americans obtain insurance.

The Senate Health, Education, Labor and Pensions Committee bill, passed earlier by a panel in which liberals predominate, calls for both a government plan to compete with private insurers and a mandate that employers help cover their workers. Those are only two of dozens of differences.

President Barack Obama acknowledges it's not going to be easy. Speaking Tuesday in the Rose Garden, Obama called the 14-9 Finance Committee vote "a critical milestone" toward getting a health care overhaul this year. The legislation won its first Republican support when Sen. Olympia Snowe of Maine broke ranks with her party, saying she was answering the call of history.

Obama wasn't ready to bask in the bipartisan glow.

"Now is not the time to pat ourselves on the back," he said. "Now is the time to dig in and work even harder."

There was no victory lap either for Finance Committee Chairman Max Baucus of Montana. "The bottom line here is we need a final bill, a merged bill, that gets 60 votes," he said. "Our goal is to pass health care reform, not just talk about it."

Aides say Reid has a keen sense of what the Senate will pass and he is focused on finding a solution that can get the 60 votes needed to overcome a Republican filibuster.

In general, bills moving toward floor votes in both houses would require most Americans to purchase insurance, provide federal subsidies to help those of lower incomes afford coverage and give small businesses help in defraying the cost of coverage for their workers.

The measures would bar insurance companies from denying coverage on the basis of pre-existing medical conditions and for the first time limit their ability to charge higher premiums on the basis of age or family size. Expanded coverage would be paid for by cutting hundreds of billions of dollars from future Medicare payments to health care providers. Each house also envisions higher taxes - an income tax surcharge on million-dollar wage-earners in the case of the House, and a new excise levy on insurance companies selling high-cost policies in the Senate Finance Committee bill.

Apart from Snowe, Finance Committee Republicans cited higher taxes, a greater federal role in the insurance industry and other concerns as they lined up to oppose the bill.

Sen. Charles Grassley, R-Iowa, said the legislation would place the nation on a "slippery slope to more and more government control of health care."

Snowe said there were problems with the bill but the risks of doing nothing were too great.

"We should also contemplate the decades of inaction that have brought us to this crossroads," she said. "The status quo approach has produced one glaring common denominator, that is that we have a problem that is growing worse, not better."

Across the Capitol, Speaker Nancy Pelosi and her lieutenants have been at work for weeks trying to blend legislation approved by three House committees. The eventual result is certain to include a government option, but the details of the plan have split the rank and file and leaders have spent days struggling with the issue.

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Associated Press writers David Espo and Erica Werner contributed to this report.