Senators Continue Work on Health-Care Bill, but Obstacles Remain

By Shailagh Murray and Paul Kane
Washington Post Staff Writers
Thursday, September 10, 2009; 6:23 PM

Senators are proposing changes to a draft health-care bill offered this week by Senate Finance Chairman Max Baucus (D-Mont.), but their work has made plain that deep divisions remain among the lawmakers a week before they are due to make their bill official.

Nevertheless, those involved in the Finance Committee negotiations remain hopeful that a bipartisan deal may yet materialize from the talks . The three Republican negotiators have offered the longest lists of changes, but most individual suggestions were relatively narrow, leaving the basic framework of Baucus's proposal intact.

But the group still appears to be struggling with how to settle the basic questions of how much health coverage should uninsured people be required to obtain, and how much the government should help to pay for it. This nettlesome challenge has dominated discussions among the negotiators -- the so-called Gang of Six -- for at least two months.

As they continued their talks, congressional Democrats on Thursday began their push to unify their ranks behind President Obama's outline for health-care legislation, hours after the president laid out that plan in a speech that was met with loud protests from some Republican lawmakers.

House Democrats held a meeting of their top vote-counters in the morning, and followed with a pair of key meetings later Thursday. One gathered a group of centrist Democrats who have been opposed to a key plank of the legislation, and the other was with party liberals who have been the loudest proponents of that proposal, known as the "public option," a government-funded insurance program that has served as the biggest fault line in the debate so far.

In addition, Vice President Biden came to the Capitol on Thursday to meet with the Congressional Black Caucus, which has joined the liberal call for a "robust public option."

Biden predicted Thursday that Congress would complete a health-care reform bill "before Thanksgiving." He added in an interview on NBC's "Today" show that Obama is "willing to sign a bill, any bill, by whatever mechanism, that in fact guarantees that there is a choice for people that is affordable."

The Senate, meanwhile, paused to pay tribute to the chamber's leading proponent of the health-care legislation, the late Sen. Edward M. Kennedy (D-Mass.), who died last month after a 15-month battle with brain cancer and whose memory Obama invoked Wednesday night.

All three Republicans involved in the Finance Committee talks want to change current medical malpractice laws. The two conservatives at the table, Sens. Mike Enzi (Wyo.) and Charles Grassley (Iowa), also want explicit language that prohibits federal funding, including subsidies for private insurance, from paying for abortions, and bars the extension of benefits to illegal immigrants. They proposed a five-year waiting period for legal immigrants to receive insurance subsidies.

Sen. Olympia Snowe (Maine), the moderate Republican in the group, proposed one major change, allowing insurers to offer national plans and to participate in state-based insurance exchanges. The Baucus proposal would permit states to form "health-care-choice compacts," allowing for the purchase of non-group health insurance across state lines.

Snowe also proposed new provisions, including a recalculation of the affordability of employer coverage, that would increase the overall price of the Baucus plan to about $900 billion over 10 years.

Enzi requested several changes to Baucus's proposed Medicaid expansion, a step aimed at easing the cost burden on states. Enzi wants a requirement that the federal government pay 100 percent of expansion costs, in order to avoid imposing an unfunded mandate on states. He would also lower the income threshold at which individuals can choose between Medicaid and private insurance.

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