The debate over a sweeping overhaul of the nation's health-care system got off to a rocky start in the Senate yesterday as lawmakers delayed action on one key bill and engaged in partisan sniping over another.
Senate leaders said they are still on track to put a bill on the floor by midsummer, but some Democrats privately acknowledged that piecing together a measure that will expand coverage to the uninsured without breaking the budget is proving excruciatingly difficult -- particularly if the goal is to pass a bill with Republican support.
"A bipartisan bill takes far more time than not," said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, which had been expected to unveil a package of reforms by tomorrow and hold a committee vote next week. Amid concerns about cost from Republicans and some Democrats, Baucus said he has agreed "to slow things down" and that committee action could be delayed until after the Fourth of July recess.
The Finance Committee package is eagerly awaited, because lawmakers, lobbyists and reform advocates believe that panel has the best chance of producing a measure that can win broad support. Baucus is working closely with Sen. Charles E. Grassley (R-Iowa) and other Republicans on the panel to hammer out a plan, along with a proposal to pay for it.
That effort hit a snag earlier this week when the Congressional Budget Office attached a $1.6 trillion price tag to a preliminary version -- far more than many senators are prepared to spend. The figure shocked key Democrats, who were scrambling yesterday to make adjustments that would slash the price by more than a third.
Among the changes under discussion, according to Sen. Kent Conrad (D-N.D.): tightening eligibility for federal subsidies to purchase insurance, which had been set at 400 percent of the federal poverty level; and potentially requiring businesses to pay more if they decide not to provide insurance coverage to their workers.
Committee members also were still struggling with the shape of a government-sponsored insurance plan that would be available to people who could not get coverage elsewhere. Republicans are opposed to any government-run plan, though they are willing to consider Conrad's proposal to form insurance cooperatives run by consumers.
The panel also had yet to settle on a financing package, though aides said members are looking at imposing a tax on the health premiums millions of families receive through their employers, with any premiums over $17,000 a year being taxed as income beginning in 2013. Setting the cap that high would generate less revenue than Democrats had hoped for, a Finance Committee aide said, forcing them to revisit an idea they had once flatly rejected: President Obama's proposal to tax high-earning families by limiting the value of their itemized deductions.
Emerging from a closed-door meeting of the panel, Baucus vowed that the final bill would clock in at less than $1 trillion over the next decade and that the committee would offer a plan to cover the entire cost. "We'll be ready when we're ready," Baucus said, "but we're not there yet."
Delicate deal-making also was going on behind the scenes at the White House, where administration officials were talking to drugmakers about voluntarily expanding prescription-drug benefits for Medicare recipients, a move that could win over skeptical seniors as well as their representatives in Congress, said House Majority Leader Steny H. Hoyer (D-Md.).
"That would be a good selling point for the legislation," Hoyer said, offering an "enhancement" to offset the inevitable "downsides" of reform with which "people are going to be upset."
Meanwhile, the Senate Health, Education, Labor and Pensions Committee was quickly mired in acrimony as it opened debate on a different plan that represents the hopes of the liberal wing of the Democratic Party.
Sen. Christopher J. Dodd (D-Conn.) -- filling in for the ailing chairman, Sen. Edward M. Kennedy (D-Mass.) -- immediately came under fire from Republicans, who questioned how they could act on a bill that is not yet complete. The measure has been given only a partial price tag by the Congressional Budget Office, which said its provision for expanding coverage would cost $1 trillion over the next 10 years and cover 16 million additional people -- about a third of the estimated 46 million Americans who do not have insurance today.
Pointing to the 600-plus page bill and 388 amendments, Sen. John McCain (R-Ariz.) said it would be "a joke if we run through this stack of papers."
Despite the rancor and the delay, lawmakers in both parties said they remain hopeful that agreement can be reached to move the issue forward. Conrad called the new timetable "much more realistic" -- and more conducive to producing a better final bill.
"Delay is not a bad thing if you are striving for some kind of bipartisan agreement," agreed Sen. Pat Roberts (R-Kan.). Asked whether such a deal seems likely, Roberts smiled and said: "Anything is possible."