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Health-Care Overhaul 2010

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As Obama Effort Hits Wall, Senators Work on Streamlined Plan

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By Lori Montgomery and Perry Bacon Jr.
Washington Post Staff Writers
Saturday, August 22, 2009

In town hall meetings across the country, voters have blasted President Obama's health-care reform plan as too expensive, too complicated and likely to inject the government too deeply into the nation's health system. In response, Senate negotiators are trying to rein in the bureaucracy, as well as the trillion-dollar price.

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But it is not clear that a smaller bill would be easier to write or to pass. Some of the simplest items on Obama's wish list could have far-reaching consequences, health experts say, and even some of the most popular provisions are beginning to draw partisan attacks.

"You start pulling these things apart, and suddenly it can all unravel in terms of policy and politics," said Roger Hickey, head of the liberal group Campaign for America's Future. If lawmakers try to cut costs by abandoning the goal of universal coverage or by trimming plans to provide federal aid to people who can't afford insurance on their own, "then the political support dries up and it's bad policy as well."

The White House doesn't appear ready to lower its expectations. "The president's goal is not to print a banner and sign a bill just so somebody can say we've reformed health care," White House press secretary Robert Gibbs said Friday. "Cutting costs, increasing coverage, ensuring that we have the type of insurance reforms that protect consumers against the type of practices that we've seen in the past -- those are part of the goals and principles that he has."

The three Democratic and three Republican members of the Senate Finance Committee who are laboring to craft a cheaper health plan say they share those goals.

But that plan must be significantly less expensive than the one crafted by House leaders, which would cost $1.02 trillion over the next decade, the senators say. And it must rein in the skyrocketing trajectory of federal health spending, rather than adding $240 billion to projected deficits by 2019, as the House plan would, according to the nonpartisan Congressional Budget Office.

Anyone who thinks the House bill, "which, number one, is not paid for and, number two, bends the cost curve in the wrong way, is a product that would pass the United States Senate, I think they're mistaken," said Sen. Kent Conrad (D-N.D.), one of the Finance Committee negotiators.

Before they left Washington for the August recess, the Finance group, known as the "Gang of Six," had crafted the outlines of a package that trimmed more than $100 billion from the House price tag and jettisoned a government-run insurance option, which has become a rallying cry for many liberals but is opposed by Republicans. The senators also were looking to provide insurance subsidies to a smaller, less affluent group than the House bill would.

After meeting via teleconference for more than an hour late Thursday, the Senate group is now looking to go further. They support a requirement that all individuals carry health insurance, but they are considering creating a bare-bones insurance policy that would be easier for people to afford without government help. They are also talking about further reducing the number of people eligible for subsidies, said an aide familiar with the talks.

"We're looking at cost savings for the government and what's affordable for people," said Sen. Olympia J. Snowe (R-Maine), another of the negotiators. "We're trying to find that magic formula."

Both ideas are likely to infuriate liberal Democrats, particularly in the House. Majority Leader Steny H. Hoyer (D-Md.) on Friday brushed aside calls to scale back the bill or break it into parts. "If you're going to solve the cost problem, you have to do this comprehensively," Hoyer said.

Hoyer left the door open, however, to dropping a public insurance plan, saying, "I'm for a public option, but I'm also for passing a bill." That set Hoyer apart from House Speaker Nancy Pelosi (D-Calif.), who declared Thursday, "There's no way I can pass a bill in the House of Representatives without a public option."

Some observers say they see plenty of room for compromise, noting, for example, that there is broad support in both parties for private-insurance reforms that would prevent higher rates based on age, sex or medical condition and denial of coverage to people who are already sick.

But this week, Senate Minority Whip Jon Kyl (R-Ariz.), indicated that he would have trouble supporting even those measures, saying states that had experimented with insurance reforms had seen "fairly disastrous consequences," including much higher premiums for people who already had coverage.

Kyl also shot down the notion that controlling the cost of the package might help. "There's no way Republicans are going to support a trillion-dollar-plus bill," Kyl said. "And when the chairman of the Finance Committee in the Senate said, 'Ah, great success, I think we've got it under a trillion dollars,' you didn't hear a lot of applause from Republicans."

Such talk is fueling speculation that the GOP wants to kill the health-reform effort and that Democrats would be better off moving forward without them.

"Some Republicans are trying to find common ground," said Jim Manley, a spokesman for Senate Majority Leader Harry M. Reid (D-Nev.). "Unfortunately, it looks like the Senate Republican leadership is trying to sabotage the process."


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