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Deeply Divided House Democrats Return to Work -- and the Same Set of Problems

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Instead, according to rank-and-file members from all corners of the caucus, lawmakers spent most of August rebutting misleading claims, such as the myth that the legislation would create federal "death panels" for elderly patients.

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"A lot of what they've heard and they don't like isn't really in the bill," said Rep. Brad Miller (D-N.C.), who supports the legislation. "President Obama needs to start talking about what's in the bill, not what's not in the bill. Whenever I see him on TV, he's talking about what's not in the bill."

The popular parts of the measure mask a deep-seated ideological conflict within the 256-member House Democratic caucus. Eventually, Hoyer and House Speaker Nancy Pelosi (D-Calif.) will have to begin choosing sides on the final makeup of the legislation, which is being compiled from the work of three committees. Each concession to one bloc of the caucus threatens to create opposition from another.

Pelosi continues to voice support for a public insurance plan, suggesting that she cannot pass a bill that does not include it. This has put her at odds with some Obama advisers, who are signaling that they are willing to do without a public option if the House and Senate can approve other major pieces of the legislation.

But liberals, whose ranks dominate the House caucus, view a public insurance plan as the linchpin of the entire effort because, they say, it fosters competition with private insurers, driving down the cost of premiums and other services.

"Health-care reform without a good public option is not health-care reform at all," said Rep. Lynn Woolsey (Calif.), a leader among House liberals. "We have to do this. That's why we're in the majority. That's why we have the White House."

Woolsey and more than 60 House Democrats sent Pelosi a letter last month vowing to vote against any reform measure that does not include a strong public option. That is more than enough Democrats to torpedo reform if Obama accepts a centrist approach.

But the latest version of the public plan in the House legislation -- the product of a late July compromise brokered by Pelosi, White House Chief of Staff Rahm Emanuel and a quartet of Blue Dog Democrats -- may be too expansive for dozens of other Democrats who want to see this plank delayed for several years or dropped altogether.

"I'm hoping we can find some middle ground," Herseth Sandlin said of the public option. "But if not, it should not be included."

Lawmakers from swing districts in the suburbs and rural regions went home to find constituents fearful of increased government involvement in the private economy. That view extends from the potential government option in health care to the bailout of the financial sector, the takeover of Detroit's carmakers and the $787 billion stimulus plan that many voters think has done little to stop job losses.

"Whether folks agree with it or not, the problem is there is so much skepticism of the elected officials, they don't believe us," said Rep. Frank M. Kratovil Jr. (D-Md.), who was narrowly elected last fall. Kratovil's recess began with a poster board image of him hanged in effigy outside his Eastern Shore office in a protest of the health-care plan. He said he remains undecided on the legislation.

Many Democrats do not want the House to act until they know what will happen in the Senate. That chamber has been stalled all summer as a bipartisan group of six senators on the Finance Committee has tried to reach a compromise that does not include a public option, costs much less than the $1.2 trillion House version and does not include a surtax on the wealthy.

If the Senate bill does not include a public option, many House Democrats will not want to vote for it in their version, because it would be unlikely to survive a House-Senate conference on the two measures.

The ultimate key to the legislation's fate in the House may rest with the roughly 80 lawmakers elected in the past three years, when the political tide was running strongly in Democrats' favor. Some come from rural districts and have joined the Blue Dog Coalition, but many are progressive in their approach to health-care reform, believing they were elected on a promise to offer change.

If enough of them can support the final legislation, leaders think they will be able to get a bill narrowly approved this fall and onto the president's desk before Christmas.

"I think, if anything, the mood has changed to be more favorable to health-care reform," said Rep. Mary Jo Kilroy (D-Ohio), who won her Columbus-based seat in 2008 by less than 1 percent of the vote.

"Personally, I'm probably more confident than when recess began," added Rep. Kathy Dahlkemper (D-Pa.), another freshman. She held 18 town hall meetings in her northwestern Pennsylvania district, which stretches from Pittsburgh's suburbs to Erie, and found that three-quarters of her constituents support some form of health-care overhaul.

"If I had just been listening to the media, I don't think I would have been as confident," she said.

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