'Gang of 6' Urged to Act Now On Health
Negotiators Pressed To Offer Proposal Before Obama Does

By Lori Montgomery and Shailagh Murray
Washington Post Staff Writers
Saturday, September 5, 2009

The chairman of the Senate Finance Committee pressured his team of health-care negotiators on Friday to agree to a bipartisan overhaul plan before President Obama addresses Congress next week, warning that otherwise he will put forward his own proposal.

Sen. Max Baucus (D-Mont.) told his five colleagues in a conference call that he wants a group decision on a bill by Tuesday. Without it, he said, he intends to propose a bill based on the finance panel's extensive policy work over the past two months, congressional sources said. Baucus pledged to the White House weeks ago that he would keep the "Gang of Six" -- all members of the Finance Committee -- on track in its already lengthy health-care negotiations.

The move by Baucus comes at a critical moment for Obama. The president's speech to Congress on Wednesday offers him the choice of preserving liberal ideals in the health-care bill, including the government insurance option that has become the focal point of the debate, or else falling in step with moderates.

Neither option presents an easy path. Democrats control both houses of Congress, but moderate Democrats are reluctant to rely on a party-line vote to pass a landmark bill, one that stokes emotions across the ideological spectrum. Republican senators still hold considerable power to obstruct legislation they do not like.

In a statement, Baucus stressed the broad areas of consensus his group forged over the past few months, but he underscored the urgency of the moment. He said the negotiators will meet face-to-face Tuesday to determine "how to best pass real reform," and added: "I am committed to getting health care reform done -- done soon and done right."

A White House official said that, while the president continues to review legislative options, he has not decided what policy objectives to endorse on Wednesday. Even reaching accord with moderates is no guarantee of passage, however.

Up to a dozen Senate Democrats are thought to oppose to some degree the federal insurance proposal -- the "public option" -- and it remains unclear how many would embrace a fallback measure that the White House is contemplating. Every Democrat who backs away means another Republican vote the White House would need to win.

The mood of the Senate is making liberal Democrats, particularly those in the House, uneasy. House Speaker Nancy Pelosi (D-Calif.) issued on Thursday an adamant defense of a "vigorous public option." Other House leaders noted that cutting the cost of the overall package, which several negotiators have said they want to do, will probably require cutting the federal subsidies to help people comply with a new mandate to buy health insurance -- an idea both parties have embraced.

"We're asking every citizen to take some responsibility for their own health care. But you can't reasonably ask somebody to do something that's totally beyond their financial means," said Rep. Chris Van Hollen (D-Md.), a member of the House leadership. "That's the trade-off."

To help ease that anxiety, Obama spoke Friday afternoon with the liberal leaders of the black, Hispanic, Asian Pacific American and progressive House caucuses. In a conference call, the lawmakers laid out their concerns to Obama about the direction of the legislative debate.

"Caucus leaders expressed absolute commitment to the idea of a robust public option, and said they expect it to be part of any health-care reform legislation," the groups said in a statement. "The president listened, asked many questions, and suggested that the dialogue should continue."

But in recent days, the White House has aggressively pursued a deal with Sen. Olympia J. Snowe (R-Maine), a member of the Gang of Six. She favors a slimmed-down bill that would take effect more slowly and would create a public insurance plan only if private insurance companies do not offer better coverage at lower rates. Under Snowe's "safety-net option," aides said, private insurance companies would be asked to develop plans affordable to 95 percent of the population in a given state or region.

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."

View all comments that have been posted about this article.

© 2009 The Washington Post Company