'Gang of 6' Urged to Act Now On Health

In areas where private firms do not comply by 2013 -- when people are scheduled to begin entering a new federal insurance exchange -- a nonprofit insurance plan sponsored by the government would be added to the list of private options.

Senior Senate aides said Baucus had not yet decided whether to include Snowe's provision in his proposal or to offer a public-option alternative -- a network of nonprofit cooperatives -- which the group already endorsed.

Some Democrats are urging Obama to cease courting Republicans and to attempt to pass a Senate bill solely with Democratic votes, to preserve the public option in its full form. But that would require Democrats in the Senate to use a legislative maneuver known as reconciliation. A reconciliation measure cannot be filibustered, so the Senate could approve health reform with 51 votes, rather than the 60 usually necessary to pass legislation in the chamber.

Even with the recent death of Sen. Edward M. Kennedy (D-Mass.), the Democratic caucus includes 59 senators, more than enough to pass a reconciliation bill. But reconciliation presents significant political roadblocks and big procedural challenges, Democrats acknowledge.

For example, both the finance and health committees would have to produce legislation that saves the government at least $1 billion by 2014. That would not be a problem for Baucus's committee, which has the power to raise taxes and to cut federal health spending. But it could be difficult for the health committee, which has already approved a bill that isn't paid for.

Another hurdle: A reconciliation measure cannot increase the deficit in any year beyond 2014, but the packages offered by the Senate health committee and by House leaders would produce bigger deficits with every passing year.

Reconciliation bills also may not contain measures that do not affect the federal budget. That, some Senate strategists said, could endanger some of Obama's top reform goals, particularly insurance reforms that would ban the practice of denying coverage to people with preexisting conditions. Other experts on the Senate said lawmakers could probably navigate around that obstacle.

The political risks are more unsettling, Democrats say. Republicans have made clear they would blast a reconciliation vote as Obama's desperate attempt to ram irresponsible measures through a reluctant Congress.

"Smart Democrats are scared of it politically," said Sen. Charles E. Grassley (Iowa), the lead Republican negotiator on the Finance compromise. "It would be very bad for them, and they know that."

Some liberals argue that Democrats should not use reconciliation unless it can produce a package that achieves their overarching goal of covering the uninsured and offering a public option, while cutting costs significantly over the long term.

Sen. Benjamin L. Cardin (D-Md.), a strong advocate of a public insurance plan, concedes that such a package is likely to be costly. "The larger the bill is, the more it's going to save," and that, he said, is the key.

"The primary goal needs to be to bring down health-care costs. If we don't do that, then the bill's not achieving our objectives," Cardin said. "If it doesn't achieve the objective, I think it would be a mistake to use reconciliation. The worst scenario is, we take responsibility and we don't get the job done."