By Lori Montgomery
Washington Post Staff Writer
Saturday, January 16, 2010; A04
President Obama and congressional leaders raced Friday to strike a compromise on far-reaching health legislation, hoping to settle lingering disputes before Tuesday, when a special election in Massachusetts could hand Republicans their 41st vote in the Senate and the power to defeat Obama's top domestic initiative.
If Republicans claim the seat held for nearly a half-century by Democrat Edward M. Kennedy, who died in August, Senate Democrats would lose their ability to overcome a GOP filibuster. Democrats said Friday that losing the seat could deal a crippling blow to the health-care measure, which last month required the vote of every member of the Senate Democratic caucus to overcome united Republican opposition.
"It will kill the health bill," said Rep. Barney Frank (D-Mass.).
Frank said he expects Attorney General Martha Coakley, a Democrat, to prevail, but Democrats nonetheless began trying to plot a health-care strategy if they lose their supermajority in the Senate. Senate aides said House Speaker Nancy Pelosi (D-Calif.) has shut down talk of the most obvious option: avoiding the need for another Senate vote by having the House approve the Senate-passed version of the health bill, rather than merging the two and having each chamber vote again. Pelosi has repeatedly said she could not rally the votes to approve a package that many House Democrats think would force people to buy health insurance without ensuring that they could afford it.
If state Sen. Scott Brown succeeds in his bid to fill Kennedy's seat, Democrats could also try to delay seating him until Massachusetts officials have certified his victory, a process that could take up to two weeks. But Kennedy took the seat within hours after winning it in a special election in 1962, and senior Senate aides acknowledged it would be difficult to justify a postponement long enough to push the health bill to final passage.
Some Democrats have raised a third option: using a fast-track procedure, known as reconciliation, that would permit the bill to pass the Senate with 51 votes. "Getting health-care reform passed is important. Reconciliation is an option," Rep. Chris Van Hollen (D-Md.), a member of the House leadership, said on Bloomberg Television's "Political Capital With Al Hunt."
But reconciliation would require lawmakers to start over, dismantle the bill and scale it back dramatically.
Throughout Friday afternoon, House and Senate leaders pressed toward an agreement between the two chambers, meeting at the White House for a third straight day. Senate Majority Leader Harry M. Reid (D-Nev.) told reporters upon returning to the Capitol that negotiators were "pretty close" to a final compromise.
Top aides were planning to work through the weekend to transmit a complete package to congressional budget analysts, who must attach a price tag to the legislation before it proceeds to final votes in the House and Senate.
Democrats briefed on the talks said negotiators were close to completing plans to create a national marketplace for insurance, as the House prefers, although the states would also have input. House negotiators were poised to accept the Senate's proposal to grant an independent board broad powers to rein in future Medicare spending.
In a separate development, Sen. Ben Nelson (D-Neb.), the last senator to sign on to the health bill last month, asked Reid to pull a controversial provision that would have fully financed an expansion of Medicaid in his state and replace it with an expensive provision that would do the same for all states. Republicans have accused Nelson of winning a special deal for Nebraska at the expense of taxpayers elsewhere.
The much-maligned provision, under which the federal government would permanently pay the cost of vastly expanding Medicaid in Nebraska, gained another critic on Friday: former president Bill Clinton.
"Get as much gunk out of the Senate bill as possible. That Nebraska thing is really hurting us," Clinton told House Democrats in a closed-door speech at the Capitol Visitor Center, said a House aide who attended the session.