Correction to This Article
This article about Democrats already looking beyond the Feb. 25 White House health-care summit incorrectly said that lawmakers who support abortion rights had sent a delegation to the White House to discuss President Obama's latest health-care proposal. Abortion rights advocates in the House say that they have renewed their request for such a meeting but that it has yet to occur, although informal discussions are ongoing.
Democrats looking beyond health-care summit to final talks within party

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writers
Thursday, February 25, 2010; A01

Congressional Democrats are already looking beyond the White House health-care summit, reckoning that Thursday's session will amount to little more than political theater and focusing instead on a final round of intraparty negotiations that are likely to determine the fate of President Obama's top domestic priority.

Although Obama is billing the White House gathering as an opportunity for Republicans to air their ideas for reform, Democrats do not expect it to reveal much common ground and are showing little willingness to abandon the basic outline of legislation that the House and Senate have approved.

"It largely depends what the Republicans come to the table with," said Sen. Christopher J. Dodd (D-Conn.), who plans to attend the summit. "If it's just coming to repeat a lot of the stuff we've heard for six months, then I don't expect much out of it." He added: "We're not going to start writing a bill all over again."

Democrats hope that after Thursday's meeting, Obama will bring a more forceful approach to his role as lead negotiator on health-care reform. To the frustration of many on Capitol Hill, the president has dipped in and out of the debate throughout the past year, offering broad objectives and cutting deals here and there with individual lawmakers but seldom putting the weight of his office behind demands for specific provisions in legislation.

Only if the president is willing to take command of the debate, Democrats in both chambers said, will a health-care reform bill have any chance of reaching his desk. "The difference here now is the president is not in a back room with his sleeves rolled up trying to play Lyndon Johnson," said Rep. Anthony Weiner (N.Y.), a leading House liberal.

"He's now out there being Ronald Reagan, Bill Clinton, Abe Lincoln -- which, you know, is what we've needed all along," Weiner said. "That's what we really need here. And that's why I believe the vote count on things is not static."

House-Senate feud

Obama's toughest audience Thursday may be members of his own party, who have been feuding since a Massachusetts special election cost Democrats their 60th vote in the Senate. House Democrats fume that the Senate took too long to pass its version of health-care legislation, causing the debate to spill into the midterm election season. Senate Democrats want their House counterparts to back off their more expensive plan and accept the bill that the Senate passed on Christmas Eve.

With a single roll-call vote, the House could send the Senate version of health-care reform directly to Obama for his signature. House Speaker Nancy Pelosi (Calif.) and Senate Majority Leader Harry M. Reid (Nev.), along with White House officials, have spent recent weeks weighing potential "fixes" to the legislation that would address House Democratic objections. Those changes could be offered as a separate bill, protected from filibuster under special budget rules known as reconciliation that would allow it to pass the Senate with a simple majority.

Those rules may also require the House to initiate action on the fixes -- a leap of faith that many House Democrats are unwilling to take. "The trust of House members . . . in the Senate delivering on anything is at an historic low," said Rep. Peter A. DeFazio (D-Ore.). "And the House taking major action that is dependent on a future action of the Senate, I think that's very, very difficult."

But Senate Budget Committee Chairman Kent Conrad (D-N.D.) said the order of the legislative process would be nonnegotiable, because the Constitution requires that all revenue-related bills -- several of the fixes would involve tax policy -- begin in the House. If the House doesn't vote first, "then it's dead," Conrad said of the health-care bill.

'A lot of questions'

Pelosi and her team have declined to discuss the process by which they hope to complete a bill, instead focusing on building support for the policy outline that Obama unveiled Monday as a potential Democratic compromise.

But rank-and-file House Democrats have an array of concerns about the proposed compromise, and "people have a lot of questions," said Rep. Chris Van Hollen (D-Md.), a member of the House leadership.

The faction that most concerns House leaders is the conservative Blue Dog coalition, which saw 24 defections when the health-care reform bill came to a vote in November. With a 10-year price tag of about $950 billion, Obama's compromise is less costly than the House measure, a point that should appeal to members of the fiscally conservative caucus. But health-care reform has become so fraught politically that House leaders worry about losing Blue Dogs who previously supported the bill, as they run for cover in their districts, which are often closely contested.

Another nettlesome issue is abortion. The Senate plan takes a slightly more lenient approach to preventing federal subsidies from paying for insurance policies that cover abortion, and abortion opponents have deemed it unacceptable. Rep. Bart Stupak (Mich.), a leader among antiabortion Democrats in the House, warned that an additional dozen Democrats could join him in voting against the Senate bill.

Abortion rights supporters are not happy, either. More than 40 House Democrats signed a letter saying they would vote against any measure that would restrict current access to coverage, and a delegation of abortion rights supporters visited the White House on Tuesday to lobby on the issue.

Immigration is also an area of contention. The Senate bill would bar undocumented immigrants from purchasing insurance through exchanges that would be created under the plan, even with their own money. Like abortion, the issue would be difficult to address in the reconciliation bill, and it is unclear whether Hispanic House members who expressed strong opposition to the Senate legislation would be willing to accept the language.

Medicare board at issue

Still other House members are pressing the White House to surrender on another key Senate proposal, supported by Obama, that would create an independent board empowered to control Medicare spending. Members of the House Ways and Means Committee oppose giving up their authority to manage Medicare, and the board was a topic of fierce discussion at a committee meeting Tuesday.

One member of the panel, Rep. Richard E. Neal (D-Mass.), said Wednesday that he could vote against a health-care reform package that includes the Medicare board, which he deemed "an indefensible transfer of legislative authority."

But House Democrats said they are open to Obama's compromise proposal for an excise tax on high-cost "Cadillac" insurance policies. Although the president has backed the idea as a way to control premiums, he has proposed delaying the tax's implementation until 2018 while raising the threshold to exempt many union plans.

First-term Rep. Gerald E. Connolly (D-Va.) said the summit marks the beginning of Obama's last, best chance to achieve his top domestic policy goal.

"It may involve hand-holding or holding of noses, but either you buy into the idea of health-care reform that transcends everything else you want to do, or you seal its fate," Connolly said. "On our side, the time for haggling is over. The question is: Do you want this, or do you want nothing?"

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