House, Senate Democrats Struggle to Find Healthcare Compromise

By | January 13, 2010

Democrats in the House struggled Tuesday to find common ground with the Senate on how to pay for a healthcare reform bill, with the differences over taxes emerging as the biggest stumbling block to a quick deal.

Returning to work at the Capitol after a nearly three-week holiday, House Democrats mapped out strategies for talks on merging the two bills and tried to find an approach that could win the necessary 218 votes in the House.

The House and Senate versions of the healthcare overhaul, President Barack Obama’s top legislative priority, must be melded into one bill and passed again by each chamber before Obama can sign it into law.

While the Senate’s need to maintain a fragile 60-vote coalition in favor of the overhaul has made its bill the likely framework for a final compromise, House Democratic leaders said winning approval would be no easier on their side of Congress.

“Forget all the other questions, 218 is the most important issue we are dealing with,” House Ways and Means Committee Chairman Charles Rangel told reporters. “We’ve got a problem on both sides of the Capitol, a serious problem.”

A shift of three votes in the House could doom the bill, which passed the House by a 220 to 215 vote in November.

The Senate has even less room for error. Its version passed on Christmas Eve with exactly the 60 votes it needed against unified Republican opposition.

Both bills would extend health coverage to more than 30 million uninsured Americans, create exchanges where individuals can shop for insurance plans and halt practices such as refusing insurance to people with pre-existing conditions.

The changes to the $2.5 trillion healthcare system would be the biggest in four decades.

But House Democrats are unhappy with several Senate provisions. The biggest obstacle is a tax on high-cost insurance plans included in the Senate bill and backed by Obama but strongly opposed by House Democrats and labor unions.

Critics say it will hit middle-class families and union members who gave up higher wages for better health benefits. House-Senate negotiators are considering raising the threshold for the tax and exempting certain industries.


To replace the lost revenue, negotiators are looking at extending the payroll tax on Medicare, the health program for the elderly, to income from investments by the wealthiest Americans.

“Nobody has been drawing lines in the sand but at the same time everybody is clearly advancing their respective positions,” Democratic Representative Chris Van Hollen told reporters.

The House also has pushed the Senate to agree to a more generous level of federal subsidies to help expand coverage to the uninsured and to adopt a single national insurance exchange. The Senate bill calls for state-based exchanges.

Supporters of a national exchange say it would allow for broader protections for consumers and stronger competition.

“I think it’s essential … to having an exchange that meets our standards,” House Speaker Nancy Pelosi said of the national exchange. “How that is defined, we’ll see.”

Pelosi, Senate Democratic leader Harry Reid and members of the Democratic leadership in both chambers will meet Obama at the White House Wednesday. Obama will speak to House Democrats Thursday.

“No one can tell you with any degree of accuracy what we are going to do. We’ve got to get a bill that’s more compatible to the House,” Rangel said.

The Senate does not return to work until next week and Democrats hope to finish the healthcare bill before Obama’s State of the Union message in early February.

“I think we’ve got to start talking to the Senate instead of talking to each other,” Representative John Dingell told reporters.

(Editing by John O’Callaghan)

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