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House Democrats: Obama's support could lead to final passage of health-care bill

By Shailagh Murray
Washington Post Staff Writer
Saturday, February 27, 2010; A04

As Democratic leaders begin to negotiate what they hope will be a health-care endgame, House Speaker Nancy Pelosi said Friday that President Obama's support for key House Democratic priorities had increased the likelihood that a version of the massive bill now stuck in the Senate could become law.

Pelosi told reporters that Obama's 11-page blueprint for health-care reform, released in advance of Thursday's White House summit, had provided the outlines of a final bill that could take shape over the coming weeks.

White House officials said Obama will announce next week how he wants Congress to proceed. Lawmakers would like to wrap up debate before Congress departs March 26 for the Easter recess, but some Democratic aides acknowledged that it might not be possible to do so.

Two questions will determine whether a health-care bill reaches the president's desk: whether Pelosi can persuade her caucus to support the more conservative proposal passed by the Senate, and whether Senate Democrats can execute the parliamentary maneuvering required to modify that legislation to accommodate the demands of the House.

Obama's decision to take a more prominent role could prove pivotal. Pelosi said the president's blueprint, although thin on specifics, outlines solutions to sticking points between the House and Senate that have prevented the bill from advancing.

For example, House Democrats have opposed a provision that would create a tax on high-value health plans. The White House would reduce the number of middle-class families that would be affected by raising the value of the plans that are taxed.

And Obama proposed dropping a controversial Medicaid provision that benefits Nebraska, added to the Senate bill in December to win the support of Sen. Ben Nelson (D-Neb.).

"I believe that we have good prospects for passing legislation in light of the recognition the president gave to the concerns of the House members," Pelosi said.

A day after the White House summit, Democrats and Republicans debated which party had gained the biggest advantage from the seven-hour session. GOP lawmakers boasted that they had forced Democrats to defend on live television a vast government expansion into health care that could drive up premiums and worsen the federal deficit.

"Americans have serious objections to this plan that will give government control over our health-care decisions," Rep. Tom Price (R-Ga.) said in a statement.

But Democrats said internal canvassing suggested the summit had reassured lawmakers that an ambitious bill was the only way to tackle an array of serious problems -- especially with Obama serving as chief spokesman.

Senate Democrats said they have identified only one path forward for the health-care bill. First, the House would have to pass the bill approved by the Senate on Christmas Eve. That bill has numerous provisions that House Democrats dislike -- such as the Nelson deal that critics have dubbed the "Cornhusker Kickback." So Congress would also have to approve fixes to the Senate bill under special budget rules known as reconciliation that would allow the fixes to clear the Senate with a simple majority.

Sen. Kent Conrad (D-N.D.), whose Budget Committee holds jurisdiction over reconciliation bills, told reporters this week that the fixes must start in the House because the House is responsible for initiating bills that deal with revenue matters. But House Democrats are highly reluctant to proceed without an ironclad guarantee that the Senate will pass the revisions.

Reconciliation was created in 1974 to make it easier for Congress to approve politically difficult bills to reduce the deficit, but it is frequently used by both parties to muscle through favored policies, including tax cuts and changes to the health-care system. For instance, reconciliation was used to create the COBRA provision to let people who lose their jobs keep their health insurance.

But although reconciliation bills are protected from filibusters, they are subject to numerous other restrictions. Under reconciliation rules included in the Democrats' current budget, the package of fixes would have to meet an overall goal of cutting the deficit by at least $2 billion over the next 10 years. And Republicans can offer unlimited amendments -- a prospect that could extend the health-care debate indefinitely.

Pelosi told reporters she was hopeful the obstacles could be overcome. "We'll put something together," she said.

Staff writers Perry Bacon Jr. and Michael D. Shear contributed to this report.

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