Dem leaders unite on health care strategy

Democratic congressional leaders are uniting around their last, best hope for salvaging President Barack Obama's sweeping health care overhaul.

Their plan is to pass the Senate bill with some changes to accommodate House Democrats, senior Democratic aides said Monday. Leaders will present the idea to the rank and file this week, but it's unclear that they will have the votes to move forward.

Last week's victory by Republican Scott Brown in Massachusetts cost Democrats the 60th vote they need to maintain undisputed control of the Senate, jeopardizing the outcome of the health care bill just when Obama had brokered a final deal on most of the major issues.

"We've put so much effort into this, so much hard work, and we were so close to doing some significant things. Now we have to find the political path that brings us out. And it's not easy," the No. 2 Senate Democrat, Dick Durbin of Illinois, said Monday.

The new strategy is as politically risky as it is bold. There is widespread support for Obama's goals of expanding coverage to nearly all Americans while trying to slow costs. But polls show the public is deeply skeptical of the Democratic bills, and Republicans would certainly accuse Democrats of ignoring voters' wishes.

Obama initially voiced doubts last week that a comprehensive bill was still viable, but he now seems to be pushing for it. Asked Monday if the president was backing away from his pursuit of major changes, White House spokesman Robert Gibbs responded: "No."

"I think the president believes that the circumstances that led him to undertake greater security for people in their health care ... existed last year, last week and this week," Gibbs added.

Lawmakers will be eager to hear what Obama has to say on health care in his State of the Union address Wednesday.

House Speaker Nancy Pelosi, D-Calif., said last week she does not have the votes to pass the Senate bill without changes. Democratic congressional aides, speaking on condition of anonymity because the issue is in flux, said the latest strategy involves using a special budget procedure to revise the Senate bill.

The procedural route - known as reconciliation - would allow a majority of 51 senators to amend their bill to address some of the major substantive concerns raised by the House. That would circumvent the need for a 60-vote majority to hold off Republican delaying tactics.

The remaining alternatives are unappealing: scaling back the health care bill to less controversial, smaller pieces, or setting it aside altogether.

Among those arguing for a quick strike on health care is David Plouffe, the political adviser who helped elect Obama president and has just been summoned back by the White House to help coordinate this year's elections.

"I know that the short-term politics are bad," Plouffe argued in a Washington Post op-ed. "But politically speaking, if we do not pass it, the GOP will continue attacking the plan as if we did anyway, and voters will have no ability to measure its upside." Among the immediate benefits: allowing dependent children to stay on their parents' coverage into their mid-twenties, and assistance for seniors in the Medicare prescription coverage gap.

Still, some moderate Democrats appear reluctant.

Sen. Ron Wyden, D-Ore., said the president and congressional leaders should reach out to Republicans. "To put up the white flag of surrender on bipartisanship when the country really wants that, I think is a mistake," Wyden said.

"I think it's important not to rush something through right now," said Sen. Ben Nelson, D-Neb.

How the new legislative strategy would work has not been fully determined. Would the House vote with only an assurance the Senate will make fixes?

One problem is that it may not be possible to resolve all the significant differences between the House and Senate bills through the special budget procedure. Only changes that affect taxes and government spending would normally be allowed to pass with a majority of 51 senators, rather than a 60-vote majority.

It's unclear that other major disputes - for example, how to restrict taxpayer funding for abortions - could be settled similarly. On abortion, the House bill is more restrictive than the Senate version.

That means Democrats might be able to resolve differences between the House and Senate on economic issues: taxing high-cost insurance plans, closing the coverage gap in the Medicare prescription benefit, and providing subsidies to help middle-income households pay insurance premiums. Likewise, they would be able to undo a special Medicaid subsidy to Nebraska that has sparked wide protests. Yet they still could be left with a bill that cannot pass both the House and Senate.

Abortion opponents say they will count any House vote for the current Senate bill as favoring new government subsidies for abortion. "I suggest they do it the other way around, fix it first and then pass it," said Douglas Johnson, legislative director for National Right to Life.

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Associated Press writer Erica Werner contributed to this report.