Senate Republicans Lose Vote on Health Law

WASHINGTON – A Republican drive to repeal the year-old health care law ended in party-line defeat in the Senate on Wednesday, leaving the Supreme Court to render a final, unpredictable verdict on an issue steeped in political and constitutional controversy.
The vote was 47-51.

AP-GfK Poll: Raw feelings ease over health law

AP - WASHINGTON – As lawmakers shaken by the shooting of a colleague return to the health care debate, an Associated Press-GfK poll finds raw feelings over President Barack Obama's overhaul have subsided.

Ahead of a vote on repeal in the GOP-led House this week, strong opposition to the law stands at 30 percent, close to the lowest level registered in AP-GfK surveys dating to September 2009.The nation is divided over the law, but the strength and intensity of the opposition appear diminished. The law expands coverage to more than 30 million uninsured, and would require, for the first time, that most people in the United States carry health insurance.
The poll finds that 40 percent of those surveyed said they support the law, while 41 percent oppose it. Just after the November congressional elections, opposition stood at 47 percent and support was 38 percent.
As for repeal, only about one in four say they want to do away with the law completely. Among Republicans support for repeal has dropped sharply, from 61 percent after the elections to 49 percent now.
Also, 43 percent say they want the law changed so it does more to re-engineer the health care system. Fewer than one in five say it should be left as it is.
"Overall, it didn't go as far as I would have liked," said Joshua Smith, 46, a sales consultant to manufacturers who lives in Herndon, Va. "In a perfect world, I'd like to see them change it to make it more encompassing, but judging by how hard it was to get it passed, they had to take whatever they could get."
His extended family has benefited from the law. A sister-in-law in her early 20s, previously uninsured, was able to get on her father's policy. "She's starting out as a real estate agent, and there's no health care for that," said Smith. The law allows young adults to stay on a parent's plan until they turn 26.
Congress stepped back last week to honor victims of the rampage in Tucson, Ariz., that left Rep. Gabrielle Giffords, D-Ariz., facing a long and uncertain recovery from a bullet through her brain.
There's no evidence the gunman who targeted Giffords was motivated by politics, but the aftermath left many people concerned about the venom in public life. A conservative Democrat, Giffords had been harshly criticized for voting in favor of the health overhaul, and won re-election by a narrow margin.

House Republican leaders say they're working to keep this week's debate — and expected vote Wednesday from degenerating into a shouting match, but it depends on the Democrats, too. Republicans want a thoughtful discussion about substantive policy differences, said Brad Dayspring, a spokesman for Rep. Eric Cantor, the No. 2 GOP leader. The AP-GfK poll was under way when the attack in Tucson took place Jan. 8.
Opposition to the law remains strongest among Republicans. Seventy-one percent of them say they're against it, as compared with 35 percent of independents and 19 percent of Democrats. Republicans won back control of the House partly on a promise to repeal what they dismissively term as "Obamacare."
"I just think that the liberal left is more going for socialized medicine, and I don't think that works well," said Earl Ray Fye, 66, a farmer from Pennsylvania Furnace, Pa., and a conservative Republican. "It just costs too much. This country better get concerned about getting more conservative."
One of the major Republican criticisms of the law found wide acceptance in the poll, suggesting a vulnerability that GOP politicians can continue to press.
Nearly six in 10 oppose the law's requirement that people carry health insurance except in cases of financial hardship. Starting in 2014, people will have to show that they're covered either through an employer, a government program, or under their own plan.
Rich Johnson, 34, an unemployed laborer from Caledonia, Wis., said he thinks the heart of the law is good. "The problem I have with it is mandating insurance so that you have to have it or you'll get fines," said Johnson, an independent. "I just don't think people should be forced to have it. The rest of it, I have no problem with."
The individual mandate started out as a Republican idea during an earlier health care debate in the 1990s. More recently, Massachusetts enacted such a requirement under GOP Gov. Mitt Romney and the Democratic Legislature. Nowadays, most conservatives are against it, and GOP state attorneys general are suing to have the mandate overturned as unconstitutional.Other major provisions of the law, including a requirement that insurers accept people with pre-existing medical conditions, got support from half or more of the public in the poll.
Loralyn Conover, 42 a former music teacher with multiple sclerosis, says she hopes repeal goes nowhere. Senate Democrats say they'll block it.
The new law "opens the door for people like me to have some kind of pay-as-you-go health insurance," said Conover, of Albuquerque, N.M. "It's nice to be able to have something . and not be dropped in the cracks of society." She couldn't get health insurance when she was first diagnosed, but is now covered by Medicare.
The AP-GfK Poll was conducted Jan. 5-10 by GfK Roper Public Affairs and Corporate Communications. It involved landline and cell phone interviews with 1,001 adults nationwide, and has a margin of sampling error of plus or minus 4.2 percentage points.

Obamacare Under the Knife

In the nearly 10 months since the Democrats' health care bill became law, bureaucrats have been feverishly writing new regulations, and the first wave of reform has arrived. There are tax credits for small businesses to cover employees; kids can stay on their parents' policies until they are 26; co-pays for preventive care went away. But to most Americans, the enactment of the Patient Protection and Affordable Care Act has felt less like the dawn of a new era and more like the start of a long partisan war over whether reform should proceed at all.

The new Republican majority in the House of Representatives will vote to repeal the entire health care reform law on Jan. 12. If (as expected) the Senate does not follow suit, the House will then try to dismantle it "piece by piece," in the words of Michigan's Fred Upton, the new chairman of the chamber's Energy and Commerce Committee. "We'll see if this thing will crumble," he says. Elsewhere, lawyers are challenging the constitutionality of central components of the law in federal courthouses and are likely to carry their arguments all the way to the Supreme Court. Republican governors are proceeding in kind, supporting those lawsuits and resisting the law inside their state borders, even as they take the millions in federal funds that come with it. (Read "After a Rocky Year, No Celebrating for Health Care Reform.")
While wholesale repeal is virtually impossible, there is no guarantee that the shaky coalition Obama glued together to get the landmark bill passed last year will hold. In the midterm-election campaigns, Democrats found themselves under fire for backing a new expansion of federal entitlements. Some of those who expect to face tough contests in 2012 may decide to hedge their bets on subsequent votes to defend or dismantle the law. One House Democrat, Dan Boren of Oklahoma, has already said he is "inclined to support the repeal." Physicians' groups, hospitals, insurers and drugmakers, which reluctantly got behind the measure last year, will stick with the law only if its implementation appears to be stable and predictable. Major legislative revisions, which are not impossible, may cause their support to evaporate. It is almost certain that the law will be changed before the 112th Congress adjourns next year.

How much? History may be a useful guide. The creation of Social Security in 1935 and Medicare in 1965 spawned lawsuits and promises of repeal too. Yet in the years that followed, neither program was scaled back. Both, in fact, were greatly expanded. Here's a look at the war on health care reform - and the fronts on which the battles of 2011 will be fought.  Leave your Comment on this story.

Obama and Republicans bicker over doctors' Medicare pay

WASHINGTON – President Barack Obama is asking Republican lawmakers to approve billions of dollars in new spending to avert a scheduled 21 percent cut in payments to doctors who treat Medicare patients.

If GOP senators don't allow the stalled proposal to pass, some doctors will stop treating Medicare recipients, Obama said in his weekly radio and Internet address Saturday.
The Senate's top Republican, Mitch McConnell of Kentucky, said his party wants to avoid reducing physicians' fees, but do it without adding to the deficit — meaning spending cuts elsewhere.
The president noted that since 2003, Congresses led by Democrats and by Republicans alike have blocked similar proposed cuts in doctors' reimbursement rates. But now, he said, Republicans are "willing to walk away from the needs of our doctors and our seniors."
The "doc fix" is part of a large, Democratic-drafted bill that would extend several popular tax breaks while greatly increasing the tax that oil companies pay into a spill liability fund. Republican senators have focused their objections on the bill's tax increases, not the doctors' pay matter.
"Even in the face of public outrage, Democrats are showing either that they just dont get it on this issue of the debt, or that they just dont care," McConnell said.
For years, lawmakers from both parties routinely have said that would trim Medicare reimbursement rates as a way to save money and make their budget plans appear more frugal. Later, in a move that watchdog groups call cynical, the lawmakers routinely undo the proposed cuts in doctor payments, which are considered politically unpalatable.
Obama acknowledged that a better plan is needed.
"I realize that simply kicking these cuts down the road another year is not a long-term solution," he said. "I am committed to permanently reforming this Medicare formula in a way that balances fiscal responsibility with the responsibility we have to doctors and seniors."
The president said he is "absolutely willing to take the difficult steps necessary to lower the cost of Medicare and put our budget on a more fiscally sustainable path. But I'm not willing to do that by punishing hardworking physicians or the millions of Americans who count on Medicare. That's just wrong. And that's why in the short-term, Congress must act to prevent this pay cut to doctors."
In the GOP weekly radio address, House Republican leader John Boehner of Ohio called on Obama to rein in government spending and accused the president of "refusing to make the tough choices" when it comes to budget cuts. While Boehner did not mention the dispute over Medicare doctor payments, he renewed his attack on the new health care law, saying its "burdensome mandates and tax increases" are stalling economic recovery.

Obama signs law finalizing health care, loan redo

Associated Press Writer Philip Elliott, Associated Press Writer – 4 mins ago


WASHINGTON – President Barack Obama has signed a law that finalizes his health care overhaul and makes the government the issuer of all federal college loans.
The president completed the measure at Northern Virginia Community College, where he emphasized new help for college students.
The legislation was the second of two steps needed for the Democratic-led House and Senate to approve a health care package affecting virtually all Americans. The new law makes a series of fixes to the one Obama approved last week. It removes some unpopular provisions among other changes.
In the same swoop, Democrats added in a rewriting of college aid.
The new law strips banks of their ability to issue federal student loans in favor of direct government lending.

Breaking News - Congress clears historic health care bill

WASHINGTON – Summoned to success by President Barack Obama, the Democratic-controlled Congress approved historic legislation Sunday night extending health care to tens of millions of uninsured Americans and cracking down on insurance company abuses, a climactic chapter in the century-long quest for near universal coverage.

Widely viewed as dead two months ago, the Senate-passed bill cleared the House on a 219-212 vote. Republicans were unanimous in opposition, joined by 34 dissident Democrats.

Obama watched the vote in the White House's Roosevelt Room with Vice President Joe Biden and about 40 staff aides. When the long sought 216th vote came in — the magic number needed for passage — the room burst into applause and hugs. An exultant president exchanged a high-five with his chief of staff, Rahm Emanuel.

A second, smaller measure — making changes in the first — was lined up for passage later in the evening. It would then go to the Senate, where Democratic leaders said they had the votes to pass it.

The nonpartisan Congressional Budget Office said the legislation awaiting the president's approval would extend coverage to 32 million Americans who lack it, ban insurers from denying coverage on the basis of pre-existing medical conditions and cut deficits by an estimated $138 billion over a decade. If realized, the expansion of coverage would include 95 percent of all eligible individuals under age 65.

For the first time, most Americans would be required to purchase insurance, and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums.

Far beyond the political ramifications — a concern the president repeatedly insisted he paid no mind — were the sweeping changes the bill held in store for millions of individuals, the insurance companies that would come under tougher control and the health care providers, many of whom would face higher taxes.

Crowds of protesters outside the Capitol shouted "just vote no" in a futile attempt to stop the inevitable taking place inside a House packed with lawmakers and ringed with spectators in the galleries above.

Across hours of debate, House Democrats predicted the larger of the two bills, costing $940 billion over a decade, would rank with other great social legislation of recent decades.

"We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans, said Speaker Nancy Pelosi, partner to Obama and Senate Majority Leader Harry Reid, D-Nev., in the grueling campaign to pass the legislation.

"This is the civil rights act of the 21st century," added Rep. Jim Clyburn of South Carolina, the top-ranking black member of the House.

Republicans readily agreed the bill would affect everyone in America, but warned repeatedly of the burden imposed by more than $900 billion in tax increases and Medicare cuts combined.

"We have failed to listen to America," said Rep. John Boehner of Ohio, leader of a party that has vowed to carry the fight into the fall's midterm elections for control of Congress.

The final obstacle to the bill's passage was cleared at mid-afternoon when Obama and Democratic leaders reached a compromise with anti-abortion lawmakers whose rebellion had left the outcome in doubt. The White House announced he would issue an executive order pledging that no federal funds would be used for elective abortion, satisfying Rep. Bart Stupak of Michigan and a handful of like-minded lawmakers.

A spokesman for the U.S. Conference of Catholic Bishops expressed skepticism that the presidential order would satisfy the church's objections.

Republican abortion foes also said Obama's proposed order was insufficient, and when Stupak sought to counter them, a shout of "baby killer" could be heard coming from the Republican side of the chamber.

The measure would also usher in a significant expansion of Medicaid, the federal-state health care program for the poor. Coverage would be required for incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014.

The insurance industry, which spent millions on advertising trying to block the bill, would come under new federal regulation. They would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions and from canceling policies when a policyholder becomes ill.

Parents would be able to keep children up to age 26 on their family insurance plans, three years longer than is now the case.

A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion would go into high gear.

For the president, the events capped an 18-day stretch in which he traveled to four states and lobbied more than 60 wavering lawmakers in person or by phone to secure passage of his signature domestic issue. According to some who met with him, he warned that the bill's demise could cripple his still-young presidency.

After more than a year of political combat, Democrats piled superlative upon superlative across several hours of House debate.

Rep. Louise Slaughter of New York read a message President Franklin Roosevelt sent Congress in 1939 urging lawmakers to address the needs of those without health care, and said Democrat Harry Truman and Republican Richard Nixon had also sought to broaden insurance coverage.

Republicans attacked the bill without let-up, warning it would harm the economy while mandating a government takeover of the health care system.

"The American people know you can't reduce health care costs by spending $1 trillion or raising taxes by more than one-half trillion dollars. The American people know that you cannot cut Medicare by over one-half trillion dollars without hurting seniors," said Rep. Dave Camp, R-Mich.

"And, the American people know that you can't create an entirely new government entitlement program without exploding spending and the deficit."

Obama has said often that presidents of both parties have tried without success to achieve national health insurance, beginning with Theodore Roosevelt early in the 20th century.

The 44th president's quest to succeed where others have failed seemed at a dead end two months ago, when Republicans won a special election for a Massachusetts Senate seat, and with it, the votes to prevent a final vote.

But the White House, Pelosi and Reid soon came up with a rescue plan that required the House to approve the Senate-passed measure despite opposition to many of its provisions, then have both houses pass a fix-it measure incorporating numerous changes.

To pay for the changes, the legislation includes more than $400 billion in higher taxes over a decade, roughly half of it from a new Medicare payroll tax on individuals with incomes over $200,000 and couples over $250,000. A new excise tax on high-cost insurance policies was significantly scaled back in deference to complaints from organized labor.

In addition, the bills cut more than $500 billion from planned payments to hospitals, nursing homes, hospices and other providers that treat Medicare patients. An estimated $200 billion would reduce planned subsidies to insurance companies that offer a private alternative to traditional Medicare.

The insurance industry warned that seniors would face sharply higher premiums as a result, and the Congressional Budget Office said many would return to traditional Medicare as a result.

The subsidies are higher than those for seniors on traditional Medicare, a difference that critics complain is wasteful, but insurance industry officials argue goes into expanded benefits.

A Look At The Health Care Bill

By The Associated Press The Associated Press –
Congressional Democrats have released a final version of President Barack Obama's health care overhaul bill in advance of a House vote planned for Sunday. Some features of the legislation, which makes changes to the bill the Senate passed on Christmas Eve:
COST: $940 billion over 10 years, according to the Congressional Budget Office.
HOW MANY COVERED: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today.
INSURANCE MANDATE: Almost everyone is required to be insured or else pay a fine. There is an exemption for low-income people. Mandate takes effect in 2014.
INSURANCE MARKET REFORMS: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.
MEDICAID: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of costs for covering newly eligible individuals through 2016. A special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity is eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remains.
TAXES: Dramatically scales back a Senate-passed tax on high-cost insurance plans that was opposed by House Democrats and labor unions. The tax would be delayed until 2018, and the thresholds at which it is imposed would be $10,200 for individuals and $27,500 for families. To make up for the lost revenue, the bill applies an increased Medicare payroll tax to investment income as well as wages for individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent.
PRESCRIPTION DRUGS: Gradually closes the "doughnut hole" coverage gap in the Medicare prescription drug benefit that seniors fall into once they have spent $2,830. Seniors who hit the gap this year will receive a $250 rebate. Beginning in 2011, seniors in the gap receive a discount on brand name drugs, initially 50 percent off. When the gap is completely eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare's catastrophic coverage kicks in.
EMPLOYER RESPONSIBILITY: As in the Senate bill, businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers' coverage. The $2,000-per-employee fee would be assessed on the company's entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker.
SUBSIDIES: The proposal provides more generous tax credits for purchasing insurance than the original Senate bill did. The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges, opening for business in 2014. The exchanges would offer the same kind of purchasing power that employees of big companies benefit from. People working for medium-to-large firms would not see major changes. But if they lose their jobs or strike out on their own, they may be eligible for subsidized coverage through the exchange.
GOVERNMENT-RUN PLAN: No government-run insurance plan. People purchasing coverage through the new insurance exchanges would have the option of signing up for national plans overseen by the federal office that manages the health plans available to members of Congress. Those plans would be private, but one would have to be nonprofit.
ABORTION: The proposal keeps the abortion provision in the Senate bill. Abortion opponents disagree on whether restrictions on taxpayer funding go far enough. The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for abortion. In plans that do cover abortion, policyholders would have to pay for it separately, and that money would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

GOP HEALTH CARE SUMMIT IDEAS: Following a bipartisan health care summit last month, Obama announced he was open to incorporating several Republican ideas into his legislation. But two of the principle ones — hiring investigators to pose as patients and search for fraud at hospitals and increasing spending for medical malpractice reform initiatives — did not make it into the legislation released Thursday. The legislation incorporates only one, an increase in payments to primary care physicians under Medicaid, an idea mentioned by Sen. Charles Grassley, R-Iowa.

Obama order on abortion locks in health care votes

President Barack Obama and House Democratic leaders struck a last-minute deal Sunday with abortion foes to secure the final few votes needed to remake America's health care system, writing a climactic chapter in a century-old quest for near universal coverage.

The House argued its way through a thicket of Republican objections toward an evening vote on the bill to extend coverage to 32 million Americans who lack it, ban insurers from denying coverage on the basis of pre-existing medical conditions and cut deficits by an estimated $138 billion over a decade.
A shouting band of protesters outside the Capitol dramatized their opposition, and one man stood up in the House visitor's gallery shouting, "Kill the bill" before he was ushered out — evidence of the passions the yearlong debate over health care has stirred.
Passage of a central health care bill already cleared by the Senate would send it to Obama for his signature. That still would leave one more step, a companion package of changes would go to the Senate.
Obama lobbied by phone from the White House, then took the crucial step of issuing an executive order that satisfied a small group of Democrats who demanded that no federal funds be used for elective abortions. "We're well past 216" votes, a majority, said Rep. Bart Stupak of Michigan, swinging behind the bill after leading the holdouts in a rebellion that had left the outcome in doubt.
Democratic aides confirmed his vote count.
After more than a year of political combat — certain to persist into the fall election campaign for control of Congress — debate on the House floor fell along predictable lines.
"The public has been grievously and purposely lied to," by Republicans in their efforts to defeat the legislation, said Rep. Louise Slaughter, D-N.Y., a clear reference to GOP accusations that included the claim that there would be death panels for elderly patients.
Republicans opposed the measure as a takeover of government health care that would cut Medicare and raise taxes by nearly $1 trillion combined. Rep. David Dreier, R-Calif., criticized the Democrats for their tactics on the House floor, but said, "the greatest outrage has always been for the bill itself."
Over and over, Democrats stressed the historic nature of the day.
"Health care isn't only a civil right, it's a moral issue," said Rep. Patrick Kennedy, D-R.I. He said his late father, Sen. Edward M. Kennedy, D-Mass., had worked his entire career for nationwide health care, and President John F. Kennedy before him.
Slaughter, read a message President Franklin Roosevelt sent Congress in 1939 urging lawmakers to address the needs of those without health care, and said Democrat Harry Truman and Republican Richard Nixon had also sought to broaden health insurance coverage.
Obama has said often that presidents of both parties have tried without success to achieve national health insurance, beginning with Theodore Roosevelt early in the 20th century.
The 44th president's quest to succeed where others have failed seemed at a dead end two months ago, when Republicans won a special election for a Massachusetts Senate seat, and with it, the votes to prevent a final vote.
But the White House, House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev., soon came up with a rescue plan that required the House to approve the Senate-passed measure despite opposition to many of its provisions, then have both houses pass a fix-it measure incorporating numerous changes.
Under the order of the day, set down by Democrats, the House was voting first on the Senate-passed bill, sending it to Obama for his signature. A final vote on the fix-it bill would follow. Its passage would set up a final showdown in the Senate, where Reid says the votes are in hand for its final approval.
Under the legislation, most Americans would be required to purchase insurance, and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums.
The legislation would also usher in a significant expansion of Medicaid, the federal-state health care program for the poor. Coverage would be required for incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014.
The insurance industry would come under new federal regulation. They would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions and from canceling policies when a policyholder becomes ill.
Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear.
Once enacted, the two bills would create a series of so-called "insurance exchanges" beginning in 2014 where consumers could shop for individual coverage that meets federal standards.
To pay for the changes, the legislation includes more than $400 billion in higher taxes over a decade, roughly half of it from a new Medicare payroll tax on individuals with incomes over $200,000 and couples over $250,000. A new excise tax on high-cost insurance policies was significantly scaled back in deference to complaints from organized labor.
In addition, the bills cut more than $500 billion from planned payments to hospitals, nursing homes, hospices and other providers that treat Medicare patients. An estimated $200 billion would reduce planned subsidies to insurance companies that offer a private alternative to traditional Medicare.
The insurance industry warned that seniors would face sharply higher premiums as a result, and the Congressional Budget Office said many would return to traditional Medicare as a result.
The subsidies are higher than those for seniors on traditional Medicare, a difference that critics complain is wasteful, but insurance industry officials argue goes into expanded benefits.

Obama Targets Insurers, Sells Reform Plan

WASHINGTON (Reuters) - President Barack Obama launched a sharp attack on health insurers on Monday and called on his fellow Democrats to rise above politics and pass a healthcare overhaul in the next few weeks.

Hitting the road to rally support in the final push for healthcare reform, Obama used a campaign-style speech to urge Democrats to approve a bill and quickly end the political wrangling that has consumed Washington since July.
"There have been plenty of folks in Washington who have said that the politics is just too hard. They've argued now is not the time for reform," Obama said at Arcadia University in Glenside, Pennsylvania.
"My question to them is: When is the right time? If not now, when?" he asked, shrugging off warnings of a political backlash in November for Democrats who back the overhaul.
"I don't know how passing healthcare will play politically, but I do know that it's the right thing to do," he said.
Obama also offered his toughest criticism yet of a health insurance industry that he said placed profits ahead of patients. "Every year, they raise premiums higher and higher," Obama said "They will keep doing this for as long as they can get away with it."
Turning up the heat, Health Secretary Kathleen Sebelius sent a letter to top companies such as Aetna Inc and Wellpoint Inc asking them to justify rate increases by making public information about costs, enrollment changes and other details.
"It's time for these insurance company CEOs to do their part to make the system more transparent for the American people," Sebelius said. "If insurance companies are going to raise rates, the least they can do is tell us why."
The Obama administration has targeted health insurers in its final push for an overhaul designed to rein in costs, regulate insurers and expand coverage to tens of millions of Americans.
Obama said failure to pass a healthcare overhaul this year would leave intact a broken $2.5 trillion healthcare system that is ravaged by greedy health insurers.

INSURERS MAKE 'A CALCULATION'
"These insurance companies have made a calculation," Obama said "They're OK with people being priced out of health insurance because they'll still make more by raising premiums on the customers they keep.
The House of Representatives is expected to vote by the end of March on the Senate's version of the healthcare bill, with Democratic House Speaker Nancy Pelosi searching for the 216 votes to pass it. The House approved its version with only three votes to spare in November.
Republican leaders say they will make healthcare reform a top issue in November's elections and urged Republican candidates to focus on the Democratic-crafted bills, which polls show are unpopular with the public.
"A vote for this bill opens an entirely new line of attack on House Democrats," Johnny Destefano, a House Republican campaign committee official, said in a memo to Republican House candidates.
"Now is the time to apply pressure and force your opponents into taking a stand on whether they will walk Speaker Pelosi's plank by supporting her last-ditch healthcare push," he said.
Republican Senate leader Mitch McConnell said the new push on healthcare would be a replay of the frantic maneuvering that marked Senate passage just before Christmas.
"Americans don't like this bill any more today than they did three months ago," he said.
But in Pennsylvania, Obama sought the public's help in rallying Congress to pass the overhaul. "It's time to make a decision," Obama said. "The time for talk is over."
The overhaul looked dead in January when Republicans deprived Democrats of their crucial 60th Senate vote by winning a Massachusetts special election, stopping negotiations to merge bills already passed by the House and Senate.
But changes to the Senate bill sought by Obama and House Democrats will be considered separately using a procedure that allows a majority vote in the 100-member Senate rather than the 60 votes needed to clear Republican procedural hurdles.
Obama proposed revisions to the Senate bill last week to ease the concerns of House Democrats, including watering down a tax on expensive insurance plans and boosting federal subsidies to make coverage more affordable.
"I think there's a lot more determination in the Congress now to get it passed," Democratic Senator Arlen Specter of Pennsylvania told reporters after Obama's speech.
"I really think there's sort of reaction on the Democratic side of getting a little angry over the duration and intensity of obstruction and a lot more determination to see it through."
In her letter to insurers, Sebelius asked executives to post on their websites the justification for any individual or small group rate increases they implemented or proposed in 2010, and continue to do so in the future.
The heads of Cigna Corp, UnitedHealth Group Inc and privately held Health Care Service Corp also received the letter.
Health insurer shares were down for the day. The Morgan Stanley Healthcare Payor index was down about 0.4 percent and the S&P Managed Health Care index was off 1 percent.
The CEO of Manpower, a global employment services company that provides temporary workers, said the uncertainty of the healthcare debate in Washington was keeping U.S. employers from hiring.
"The concern is that we have a political system that is too broken to fix systemic issues," CEO Jeff Joerres told Reuters.

Obama's Health Care Pitch to Democrats: Trust Me

WASHINGTON (AP) --
 In private pitches to Democrats, President Barack Obama says he will persuade Congress to pass his health care overhaul even if it kills him and even if he has to ask deeply distrustful lawmakers to trust him on a promise the White House doesn't have the power to keep.
That, in a sometimes darkly joking way, is what the president is telling Democratic House members as he begins an all-out push to coax Congress into passing his proposals despite voters' misgivings and Republicans' dire warnings.
''He made the case, 'Listen, we put in a very hard year working on health care reform and the time for action is now,''' said Rep. Ron Kind, D-Wis., one of several Democrats who met with Obama at the White House on Thursday.
Obama joked that the political battle has contributed to the recent rise in his cholesterol, Kind said, and the president noted how ironic it would be if health care drove him to his grave.

Unwelcome Spotlight Falls on Obama Chief of Staff

The Associated Press reports -  No-drama Obama was bound to get fireworks when he chose the expletive-spewing, hotheaded, never-at-rest Rahm Emanuel to be his White House chief of staff. The only questions were when -- and how big.
The answers are now -- and pretty large, by inside-the-Beltway standards, anyway.
And they're happening at a particularly unpleasant time in Barack Obama's presidency, which is struggling with problems in terrorist policy, health care reform and other matters that have the president in political hot water and down in the polls.
The strange, only-in-Washington story began unfolding about two weeks ago when a column in The Washington Post asserted that Obama's ''first year fell apart in large part because he didn't follow his chief of staff's advice on crucial matters.''
The piece advised a 180-degree turn from the recent trend of blaming Emanuel for Obama's woes and of calling for the former congressman from Illinois to go. Instead, it said, blame others in Obama's orbit who are too ''in love with the president'' to advise him wisely on such things as health care strategy, the closing of the U.S. military prison at Guantanamo Bay, Cuba, and how and where to try accused Sept. 11 terrorists. Blame Obama himself for not listening more to Emanuel, columnist Dana Milbank wrote.
Then this week came another Post story saying basically the same thing, based largely on interviews with Democrats on Capitol Hill. This was harder for the White House to shrug off, because it was not an opinion piece but in the news section -- on the front page, no less.
Suddenly, the Obama White House had to deal with a narrative that some (though it's still unclear who) think Obama's chief of staff is smarter than the president, an awkward development in Washington's deeply ingrained tradition of aides staying behind the scenes and not upstaging the boss.
At the least, it creates an embarrassment and a distraction at a perilous time. And it belies Obama's own prized no-drama culture, where neither dirty laundry nor disagreements are aired and theatrics aren't tolerated. At worst, it sets in motion a dynamic that could lead to shakeups and further doubts about Obama's leadership.
So some angst behind the scenes at the White House was no surprise.
Publicly, however, the White House stood firmly behind Emanuel. White House press secretary Robert Gibbs on Tuesday dismissed as ''parlor games'' the talk of a White House divided into camps or of Emanuel facing the prospect of being ousted.
''Knowing most of what goes on here, I don't subscribe to all of it or a lot of it,'' he said. ''He absolutely has the president's confidence.''
Several current and former White House aides said Emanuel, despite his often passionately delivered opinions, is, once a decision is made, among the most loyal and energetic about making it happen. The president was said to view the spate of stories with a long view, that he and his team would rise -- or fall -- together and that Emanuel is too valued to cut loose.
Emanuel has been open about harboring political ambitions beyond the White House, specifically to run for Chicago mayor. But Gibbs deemed it unlikely that the chief of staff is feeding the stories himself to protect his reputation from its recent battering, particularly from the Democratic Party's liberal wing, which feels abandoned by Obama on many issues.
''We all give advice to the president on a daily basis,'' Gibbs said. ''The president makes decisions and we move forward. When we move forward, nobody moves forward with more determination than the chief of staff.''
Some indications point to the stories being driven by Emanuel loyalists, becoming increasingly upset at the criticism aimed at him lately over Obama's sputtering agenda, say those inside and outside the White House. A large number of Democratic lawmakers, particularly centrists and conservatives, feel a huge debt to Emanuel from his days as chairman of the Democratic campaign committee in 2006, when he played an instrumental role in restoring his party to power after 12 years in the minority.
Many of those same Democrats now fear for their chances in November's midterm congressional elections. As is common at this stage in an election cycle, they are looking for more help from Obama and someone to blame if they lose.
And yet, there is no doubt that Emanuel's own pugnacious, loquacious style is to blame, at least indirectly if not more.
Emanuel is known as a fierce competitor, who strikes back -- hard -- when hit.
He also fairly openly shares where he stands on issues, and where that has differed with the president.
For instance, it's well-documented that Emanuel argued internally against trying accused Sept. 11 mastermind Khalid Sheikh Mohammed and four of his alleged henchmen in civilian court in New York. That decision, by Attorney General Eric Holder, invited a firestorm of criticism for Obama, has now been put on hold and may be reconsidered.
Back when the cool-tempered Obama first offered him the job, Emanuel surprised many by publicly and repeatedly sharing his reluctance to do so -- because it would require him to give up his goal of becoming House speaker and would cost him time with his wife and three children. Such admissions of doubt when a president comes calling, which Emanuel still talks about, are almost unheard of.
The man nicknamed ''Rahmbo'' has been no stranger to controversy, either. Recently, he apologized for using the word ''retarded'' to describe liberal activists whose tactics on health care he questioned.
Obama has not been shy about getting rid of aides; he doesn't employ loyalty just for the sake of it.
But Obama has welcomed disagreement within his staff and has shown he is willing to tolerate a lot to get the benefit of Emanuel's considerable legislative and political talents. So the word is that Emanuel isn't going anywhere. For one thing, he is regarded as essential to shepherd health care reform to a conclusion.
And that, said those close to the White House, is the way out of this mess.
If health care is passed, the bad stories and the finger-pointing stop and Obama moves on to other issues.
If health care fails, there will be more bad stories and finger-pointing -- common in times of trouble for any president. And they're likely to be not just about Emanuel, but others in the White House as well.

President Obama open to adding GOP ideas to health plan

Associated Press Writer Erica Werner,
reported this about 8 mins ago

WASHINGTON – President Barack Obama said Tuesday he was open to four new Republican proposals on health care legislation, a gesture of bipartisanship meant to jump-start his stalled drive to overhaul the system.
Obama detailed the ideas, all of which were raised at a bipartisan health care summit last week, in a letter to congressional leaders. In a nod to his 2008 presidential rival, Obama also said he had eliminated a special deal for Medicare Advantage beneficiaries in Florida and other states that drew criticism at the summit from Sen. John McCain, R-Ariz.
The proposals Obama listed are: sending investigators disguised as patients to uncover fraud and waste, expanding medical malpractice reform pilot programs, increasing payments to Medicaid providers and expanding the use of health savings accounts.
"I said throughout this process that I'd continue to draw on the best ideas from both parties, and I'm open to these proposals in that spirit," wrote Obama, who will make remarks Wednesday at the White House on a path forward for his legislation.
He rejected the GOP's preferred approach of scrapping the existing sweeping overhaul bills and starting afresh with step-by-step changes.
House Speaker Nancy Pelosi, D-Calif., said Obama's letter "brings us just another step closer to passing the bill."
"We hope to incorporate some of the suggestions," she said.
Obama's announcement did not appear to win over any Republicans, who complained the underlying legislation remained fatally flawed, and the Senate GOP leader warned of reprisals in this fall's midterms elections if the Democrats go forward. But it could give wavering Democrats political cover by showing the White House has been willing to compromise in the wake of last week's summit.
"We're anxious to get health care done, which we will get done," Senate Majority Leader Harry Reid, D-Nev., said after Obama released the letter. Democrats proceed at their own political peril, said Senate Minority Leader Mitch McConnell, R-Ky.
"I want to assure our Democratic friends that if they are somehow able to pass this bill in the House, it will be the issue in every race in America," McConnell said.
At its core the Democrats' legislation would extend coverage to 30 million uninsured Americans over 10 years with a first-time mandate for nearly everyone to buy insurance and a host of new requirements on insurers and employers. However, the package soon to reach the House will be less expensive than the one the House passed in November and will contain no government-run insurance program to compete with private insurers, making it more appealing to some moderates.

Democrats are eyeing a controversial procedure known as "budget reconciliation" to get the legislation to Obama. Under this process, the House would pass the Senate-passed overhaul bill, and both chambers would pass a package of changes to the legislation designed to appeal to House Democrats. The changes — they could include Obama's suggested Republican ideas — could pass under budget rules allowing a simple majority vote in the Senate. It's Democrats' only way forward because Republicans control 41 Senate votes, just enough block the 60-vote supermajority usually required for action.
But the approach infuriates Republicans, even though they've used it in the past, and makes some Democratic moderates uneasy. White House chief of staff Rahm Emanuel defended the tactic after emerging from a meeting at the Capitol with Reid and House Speaker Nancy Pelosi, D-Calif.
"Reconciliation is a vehicle that's been used many times," Emanuel said. "This is a normal procedure, nothing different out of it."
Obama said he was open to these four GOP ideas:

Conducting undercover investigations of Medicare and Medicaid providers to search for waste, fraud and abuse, an idea put forth by Sen. Tom Coburn, R-Okla., at least week's summit.

 Experimenting with specialized health courts as an alternative to jury trials in medical malpractice cases to cut down on defensive medicine. That idea has been promoted both by Democrats and Republicans, including Coburn and Sen. Mike Enzi, R-Wyo., who attended the summit.
The approach calls for an expert judge — not a jury — to hear the evidence and make a final determination in cases where a patient has suffered harm. Trial lawyers are strongly opposed to the concept.
Months ago, Obama budgeted $23 million for states to experiment with alternatives to malpractice litigation, but at the time he stopped short of endorsing health courts. The president now says he wants to more than double the budget for state experiments to $50 million.
Obama also agreed that health savings accounts would be offered in new markets his plan sets up for individuals and small business to purchase coverage. Sen. John Barrasso, R-Wyo., brought up the idea at the summit.
The president said he's open to the tax-sheltered accounts, which go hand-in-hand with high-deductible health insurance policies. Premiums on those policies are lower than for regular health insurance, and people who have them use the health savings accounts to pay their out-of-pockets costs.
Obama also suggested increasing reimbursements to Medicaid providers, a concern raised by Sen. Charles Grassley, R-Iowa.
"That's just one thing," Coburn said of the president's desire to incorporate his proposal. "We need to start over," Coburn said, contending the bill doesn't address underlying issues of health care costs and quality.
Grassley said Obama's willingness to include his idea didn't change his opposition to the overall legislation. "There are other things more important," like its lack of caps on liability damages and its inclusion of an individual mandate, he said.
Democrats argue that the GOP calls to scrap the existing legislation and start anew further their argument that Republicans have been unreasonably opposed to almost any compromise, justifying the White House decision to push for passage with no GOP help at all.
Sen. Bill Nelson, D-Fla., said he hadn't seen Obama's proposal to eliminate the provision he championed to let about 800,000 Florida seniors enrolled in Medicare Advantage plans keep their extra benefits. But, Nelson said, "I do not think it should be removed."

9 Dems who voted no on health bill may reconsider

Associated Press Writer Charles Babington, Associated Press Writer
WASHINGTON – Nine House Democrats indicated in an Associated Press survey Monday they have not ruled out switching their "no" votes to "yes" on President Barack Obama's health care overhaul, brightening the party's hopes in the face of unyielding Republican opposition.
The White House tried to smooth the way for them, showing its own openness to changes in the landmark legislation and making a point of saying the administration is not using parliamentary tricks or loopholes to find the needed support.
Democratic leaders have strongly signaled they will use a process known as "budget reconciliation" to try to push part of the package through the Senate without allowing Republicans to talk it to death with filibusters. The road could be even more difficult in the House, where Speaker Nancy Pelosi is struggling to secure enough Democratic votes for approval, thus the effort to attract former foes.
The White House said Obama will outline his final "way forward" in a Washington speech Wednesday, and he is expected to embrace a handful of Republican ideas for making health care more efficient.
Few in Washington think those gestures will be enough to persuade a single House or Senate Republican to embrace the legislation. But they could give wavering Democrats political cover by showing the party has been willing to compromise, ammunition against campaign accusations this fall that they rammed the bill through Congress with no regard for other views.
The proposal would impose new restrictions on insurance companies and order health insurance coverage for as many as 30 million Americans who now lack it, among many other changes.

Persuading lawmakers to change their votes is a tough sell. Elected officials are loath to vote two ways on a controversial issue, feeling such a switch draws more resentment than support overall. Democratic leaders stress that the legislative package soon to reach the House will be less expensive than the one that passed in November and will contain no government-run insurance program to compete with private insurers.
They hope those changes will give additional cover to party moderates thinking of switching from no to yes.
The House version of health care passed 220-215 in November, with 39 Democrats voting against it. Since then, defections, resignations and a death have taken away yes votes.

With four House seats now vacant, Pelosi would need 216 votes to approve the Senate-passed version, which replaces the jettisoned House bill. That's exactly the number she has now if no other members switch their votes.
In interviews with the AP, at least nine of the 39 Democrats — or their spokesmen — either declined to state their positions or said they were undecided about the revised legislation, making them likely targets for intense wooing by Pelosi and Obama. Three of them — Brian Baird of Washington, Bart Gordon of Tennessee and John Tanner of Tennessee — are not seeking re-election this fall.
The others are Rick Boucher of Virginia, Suzanne Kosmas of Florida, Frank Kratovil of Maryland, Michael McMahon of New York, Scott Murphy of New York and Glenn Nye of Virginia. Several lawmakers' offices did not reply to the AP queries.
Rep. Walt Minnick of Idaho will not change his vote from no, his spokesman, Dean Ferguson, said Monday night. Minnick had declined to state a position when contacted earlier by the AP.
Both parties have used the "reconciliation" strategy to pass big bills before, but Republicans call the health care push an unwarranted departure from standard practices.
Top Democrats are reminding colleagues and voters at home that the Senate already has passed its version of the health care bill on Christmas Eve with a super-majority of 60 votes, which squelched a GOP filibuster without resorting to reconciliation rules. The new plan calls for the House to pass that same bill and send it to Obama for his signature.
But that is contingent on a Senate promise to make several subsequent changes. Those would have to be approved under the special budget reconciliation rules, because Democrats now control only 59 of the Senate's 100 votes — one shy of the number needed to stop a bill-killing filibuster.
Democratic leaders have asked colleagues not to use the term "reconciliation" but instead to refer to the process as "majority vote," said Rep. Allyson Schwartz, D-Pa. They also are frequently using the term "up or down vote."
The political math in the House is daunting. Many lawmakers expect further defections, especially members who oppose legalized abortion and feel the Senate language is too permissive in regulating federal funds for those operations.
For every yes vote that switches to no, Pelosi and the White House must persuade one of the 39 Democrats who voted "nay" in November to switch to yes.
Obama's announcement on Wednesday is expected to be a freshened blueprint of what he wants to see in a final health care bill, updated with ideas that at least have the fingerprints of Republicans.
The plan will replace the one Obama posted one week ago, but will not be written in legislative language.
Obama's move underscores his ever-growing role in shaping what he hopes will be a far-reaching revision to the nation's health care system, a goal that has eluded other presidents dating to Theodore Roosevelt.
Politically, it would also allow him to say that he was listening to Republicans at his ballyhooed bipartisan summit last week and that he has since responded by including more areas of common ground.
But Republicans have shown no sign of backing his proposal no matter how it is changed.
Obama also will outline how he wants the process to unfold in Congress. Officials signaled it will involve Senate reconciliation rules unless there's a stunning last-minute overture from Republicans.
White House spokesman Robert Gibbs would not confirm that plan Monday. But he repeated that health care deserves an up-or-down vote and that Republicans have used reconciliation on major legislation.
When asked if the public cares about legislative process, Gibbs said: "I think the American people care about what's in the bill."
Since Thursday's summit, Obama has been involved in a series of meetings in which the new White House proposal is being shaped.
Gibbs said Obama has worked to get votes in every round of the health care debate. "I don't doubt that he will ... do the same thing this time to get the votes necessary to pass health care," Gibbs said.
Rep. Eric Cantor of Virginia, the House's second-ranking Republican, made it clear that Republicans see a Democrats-only bill as an election-year issue.
"If Speaker Pelosi rams through this bill," he said this weekend, Democrats "will lose their majority in Congress in November."
Meanwhile Monday, Obama's argument that private insurance plans serving one-fourth of Medicare recipients are significantly overpaid got support from a report to Congress by nonpartisan technical advisers. Democrats have targeted Medicare Advantage plans for a big chunk of the cuts that would free funds to cover the uninsured.
The report by the Medicare Payment Advisory Commission found that last year Medicare spent about $14 billion more for seniors enrolled in private plans than would have been the case if those beneficiaries had stayed in the traditional program. One consequence was that all Medicare recipients _whether in private plans or the traditional program_ ended up paying an additional $3.35 a month in premiums to cover the costs.
The Senate health care bill that Obama supports would replace the current payment formula for the private plans with an approach based on competitive bidding.

Snowmageddon Can Still Kill Health Care Reform

February 26, 2010, 1:51 pm

Washington’s “Snowmageddon” may have already passed. But the storm still has the power to kill Washington’s health care reform talks, perhaps for good.
Take a look at where the health care reform process is now. Despite high hopes, Thursday’s much anticipated summit meeting did not seem to move the needle much. And yet, even with cannons to the left of them and cannons to the right of them, Democratic leadership vowed to charge forward.
“If nothing comes of this we’re going to press forward,” The Times quoted Senator Richard J. Durbin of Illinois, the No. 2 Democrat, as saying. “We just can’t quit. This is a once-in-a-political-lifetime opportunity to deal with a health care system that is really unsustainable.”
The implication is that Democrats regard the impasse as an extension; health care reform is, after all, a long-term question, and not one that had to be resolved by Thursday, per se. But how long will this “once-in-a-political-lifetime opportunity” to address the long-term issue last?
My guess: The deadline is probably one week from today, when the February jobs report comes out.
That report will probably be very, very ugly. I have seen some forecasters project job losses as high as 100,000.
The main culprit behind the expected jobs plunge is the blizzard, which closed businesses and kept people from going to work or even seeking work for days and sometimes weeks. These work stoppages probably occurred precisely when the government was collecting data for its February jobs report.
The Labor Department is of course very aware that the blizzard will distort its numbers. In fact, labor officials will probably try to isolate the effects of the storm from all the other data so economists can get a better sense of what’s going on in the economy. Offcials did this after previous major weather events like the 1996 East Coast blizzard and Hurricane Katrina.
But even though everyone will know that “snowmageddon,” and not President Obama, is really at fault for the poor report, the headline number may still be shocking enough to sufficiently discredit economic policy of Democrats. And all other economic policy debates, including health care which will be set against this backdrop of the Democrats’ failed stewardship of the economy.
Worsening economic dysfunction, at least when it comes to Main Streeters, sends a powerful message to Americans who believe that Democrats want a “government takeover of 17 percent of the United States economy.”
After all, if you were a Republican hell-bent on derailing health care reform, that's what I'd do.

Our Own Health Care Clash of the Titans - Just My Perspective

The underlying premise, as I see it, from the President's perspective was simply that we agree on many things, so why don't we modify the finer points on the things upon which we agree and negotiate by adding and subtracting on the points on which we do not agree. The Republican response was that we do not wish to participate; if you can pass the bill, pass it; if you can't, we will let the people decide in November. At one point the President actually conceded on that point. I believe that the President's motives were sincere in the sense that he would take an agreement that achieved less than he wanted, if he could have gained traction in the "process." Ramming the bill through Congress using reconciliation will give added ammunition to the Republicans in November. The size of the bill, the length of the debate and the endless bickering has drained the American psyche at a time when the majority have more pressing concerns such as the economy, unemployment and the next wave of property foreclosures.   In the final analysis the argument has been reduced to this one point: can government administer this massive legislation in an efficient manner.  I don't think so.... they've never done so before.  The unfortunate reality is that both sides are right and a bridge across the philosophical divide constructed by men of good will serve as the best path forward.

Obama to GOP on health care: `Let's get this done'

Associated Press -
WASHINGTON – President Barack Obama said Saturday he is ready to compromise with Republicans on health care if they are serious about it, but that an overhaul must go forward. "Let's get this done," he said.
Obama's comments in his weekly Internet and radio address, two days after an all-day bipartisan summit across from the White House, were the latest sign that Democrats are getting set to try to pass health care legislation without any Republicans on board.
Success will require colossal efforts on the part of Obama and Democratic leaders to round up votes after a year of corrosive debate and a Senate special-election upset that threw the overhaul effort into limbo last month. But Obama and the Democrats reject the piecemeal approach sought by Republicans and have no intention of scrapping their 10-year, $1 trillion bill and starting over, as the GOP demands.
"I am eager and willing to move forward with members of both parties on health care if the other side is serious about coming together to resolve our differences and get this done. But I also believe that we cannot lose the opportunity to meet this challenge," Obama said.

"The tens of millions of men and women who cannot afford their health insurance cannot wait another generation for us to act. Small businesses cannot wait. Americans with pre-existing conditions cannot wait. State and federal budgets cannot sustain these rising costs.
"It is time for those of us in Washington to live up to our responsibilities to the American people and to future generations," Obama said.
Obama's legislation would insure some 30 million more Americans over 10 years with a new requirement for nearly everyone to carry insurance and would end insurance company practices such as denying coverage to people with medical problems. Republicans generally oppose mandates that make everyone get insurance, and although they want people with health conditions to be able to buy insurance, they would try to address the problem without new requirements on insurers.
Obama plans to release an updated proposal in the week ahead, likely on Wednesday, according to press secretary Robert Gibbs. Gibbs suggested it would include concepts put forward by Republicans at the summit. One attendee, Sen. Tom Coburn, R-Okla., was contacted Friday by the White House and asked to submit details of suggestions he made to tackle waste and fraud in the medical system, Coburn's spokesman said.
John Hart said Coburn views Obama's legislation as a government takeover and would not be able to support it even if it includes some of his proposals.
Adding Republican ideas is not likely to win Republican votes because the GOP insists Democrats should start from scratch. But Obama would be able to say that he'd listened to Republicans and attempted to meet them part way. Moving ahead may mean using Senate rules that would let Democrats pass legislation with a simple majority instead of the 60 vote they no longer command.
The approach infuriates Republicans and is opposed by some Democratic moderates because of its partisan nature.
Coburn, in the GOP's weekly address, argued against a Democrats-only bill.
"Unfortunately, even before the summit took place the majority in Congress signaled its intent to reject our offers to work together," Coburn said. "Instead they want to use procedural tricks and back-room deals to ram through a new bill that combines the worst aspects of the bills the Senate and House passed last year."
"The American people are telling us to scrap the current bills, which will lead to a government takeover of health care, and we should start over," Coburn said.

White House: Announcement next week on health care

WASHINGTON – The White House says President Barack Obama will announce his plans next week for a "way forward" on long-stalled health care legislation.

White House press secretary Robert Gibbs told reporters on Friday that Obama officials and Democratic leaders in Congress will hold a few days of consultations before an announcement by the president on the next steps. Gibbs said the coming days will be a "fairly dynamic process."
Democratic leaders are also vowing to resurrect a comprehensive overhaul, with or without Republican suggestions or votes.

After healthcare summit: What's next?

Washington

After a day-long White House summit on healthcare, Republicans returning to the Senate said that President Obama and the Democrats appear ready to go it alone on this issue.
“They’re not interested in putting a 2,700-page bill on the shelf,” said Senate Republican leader Mitch McConnell of Kentucky, referring to GOP demands that the president start over with a step-by-step approach, focusing on issues on which there is broad agreement.
At the end of the summit, Mr. Obama said, “I did not propose something complicated just for the sake of being complicated.” He added, “The reason we didn’t do it is it turns out baby steps don’t get you to the place where people need to go.”
To get a bill without 41 Senate Republicans means resorting to a process called reconciliation. The process allows measures that meet certain budget criteria to pass by a simple majority, instead of the 60 votes now typical for major bills.
In the dictionary, “reconciliation” means bringing together, conciliation, or fence mending. But on the floor of the US Senate, it’s pure procedural warfare.
Liberal activists are urging Democrats to get back to the principle of majority rule in the Senate, now seen as the graveyard for much of the Obama agenda. But moderate Democrats are wary of a move that could further alienate the public from a comprehensive healthcare reform.
A new Gallup poll, released Thursday, reports that most Americans oppose using reconciliation, by a margin of 52 percent to 39 percent. Nine percent were unsure.
On Feb. 23, Sen. Robert Byrd (D) of West Virginia, the leading in-house defender of the Senate traditions, urged his colleagues to allow filibusters to run their course and not change rules to block them.
“The Senate is the only place in government where the rights of a numerical minority are so protected. Majorities change with elections. A minority can be right, and minority views can certainly improve legislation,” he wrote in a letter to his Senate colleagues.
“Extended deliberation and debate – when employed judiciously – protect every senator, and the interests of their constituency, and are essential to the protection of the liberties of a free people,” he added.
Sen. Kent Conrad (D) of North Dakota, who chairs the Senate Budget Committee, says that there could be a role for reconciliation in the healthcare debate, but only “in a very limited way”: First, the House must pass the Senate bill, then use reconciliation procedures to “fix” the bill. “You cannot do the whole healthcare bill through reconciliation. It will not work,” he adds.
If Democrats opt to push healthcare reform through the Senate using reconciliation, “the opposition to it would be bipartisan,” said Senator McConnell after the summit.

Obama, GOP fail to reach accord on health bill

Associated Press -
WASHINGTON – Giving no ground, President Barack Obama and Republican leaders fought forcefully for their competing visions of historic health care reform Thursday in an exhausting, often-testy live-on-TV debate. Far from any accord, Obama signaled the Democrats were prepared to push ahead for an all-or-nothing congressional vote.
The marathon, 7 1/2-hour session did reveal narrow areas of agreement on the topic that has vexed Congress for months and defied U.S. leaders for decades. But larger ideological differences overwhelmed any common ideas, all but cementing the widely held view that a meaningful bipartisan health care bill is not possible as time grows short in this election year.
Obama rejected Republican preferences for starting over, discussing the issue much longer or dealing with it in a limited, step-by-step fashion.
"We cannot have another yearlong debate about this," Obama declared. "I'm not sure we can bridge the gap."
Party officials said March is probably the last chance to act.
It has been more than a year since he proposed his overhaul, which would be important to virtually all Americans in remaking the way they receive and pay for health care. The version he embraces, basically tracking legislation passed by the Senate, would expand health coverage to some 30 million people who lack it and stop insurance companies from dropping people for questionable reasons or denying coverage to people who have certain illnesses.
Obama and the Democrats portray the current situation as a major crisis, with tens of millions of people left with no health insurance at all and health care costs threatening to bankrupt the nation. The Republicans see problems as well, but seek more modest steps to deal with them and say Obama's plan would run up the federal deficit — despite his claims to the contrary.
Obama strongly suggested that Democrats will try to pass a sweeping overhaul without GOP support, by using controversial Senate budget rules that would disallow filibusters. And then, he said, this fall's elections would write the verdict on who was right.
Democratic leaders tried to portray Republicans as hypocrites for denouncing parliamentary tactics they, too, have used. Democratic leaders hope to embolden colleagues who worry about re-election races in the face of polls showing substantial dislike for the party's approach.
The Democrats-only strategy could face particularly strong resistance in the House, where 39 party members voted against an Obama-backed health care bill last year.
Democratic officials confirmed Thursday that the White House has developed a slimmed-down health care plan as a possible "Plan B" fallback.
But that contingency also faces problems, including possible defections from House liberals who insist the overhaul must be expansive. Democratic officials conceded it's possible that no health care legislation will pass this year, which would leave their candidates with little to show while Republicans claimed a big win.
At Thursday's summit, Rep. Eric Cantor, the No. 2 House Republican, agreed with Obama that "we have a very difficult gap to bridge here." But he differed strenuously about resolving it. "We just can't afford this," he said of the $1 trillion, 10-year proposal. "That's the ultimate problem."
Cable news networks carried long portions of the summit, which featured 38 lawmakers sitting around a square table heaped with documents and notepads. They spoke of arcane issues such as insurance "rescissions" between sharp partisan exchanges. Moderator Obama, looking annoyed at times, interrupted Republicans fairly often, and a few of them interrupted him back.
At one point, Senate Republican leader Mitch McConnell of Kentucky accused him of shortchanging the GOP on opportunities to speak.
With the conversation veering between mind-numbing detail and flaring tempers, the two sides held onto long-entrenched positions.
Sen. Lamar Alexander, R-Tenn., derided Obama's plan. "This is a car that can't be recalled and fixed," he said, "and we ought to start over."
Alexander challenged Obama's claim that insurance premiums would fall under the Democratic legislation. "You're wrong," he said. Responded Obama: "I'm pretty certain I'm not wrong."
Democratic officials said House and Senate leaders will confer with colleagues in coming days or weeks to see if they have enough votes to push a far-reaching bill through both chambers with no GOP help.
Republicans repeatedly pressed Obama to renounce the possibility of using "budget reconciliation" rules to push the Democratic plans through the Senate without allowing GOP filibusters. Obama brushed them off, saying they seemed more interested in process than substance.
Americans want a decision on health care, the president said, and most of them think "a majority vote makes sense." Democrats control 59 of the Senate's 100 seats, one vote short of the number needed to halt bill-killing filibusters.
Top Democrats described the summit as the beginning of the end of their long push to overhaul health care, a bid rocked by raucous, conservative-dominated forums last summer that threw Democrats on the defensive. Eyeing the November elections, rank-and-file Democratic lawmakers are desperate to resolve the debate and focus on jobs and economic revival.
"If nothing comes of this, we're going to press forward," Democratic Senate Whip Richard Durbin told reporters during a break in the summit. "We just can't quit."
One of the sharpest exchanges occurred between Obama and Sen. John McCain, the Arizona Republican he defeated for the presidency. As McCain criticized numerous provisions in the Democrats' plan, Obama said, "we're not campaigning anymore. The election is over."
McCain laughed and said, "I'm reminded of that everyday."
At another point, McCain refused to yield to Obama, saying, "Can I just finish please?"
Obama ribbed Cantor, the House GOP whip, for bringing to the table the 2,400-page Senate bill, which the Virginia congressman described as too costly, bureaucratic and intrusive. Obama called it a political prop, and said health care is a complex issue that can't be reduced to snippets.
Republicans repeatedly noted that polls suggest Democrats are on the wrong track. A USA Today/Gallup survey released Thursday found Americans, by 49 percent to 42, lean against Democrats forging ahead without any GOP support. Slightly more than half oppose the idea of Senate Democrats using budget rules to bar filibusters to stop the bill.
Congressional aides said top Democrats will take a few days to gauge the summit's impact on the public and, perhaps more importantly, on moderate House members who are likely to determine whether any health care bill will pass.
If the effort fails, Democrats may try a scaled-back plan to insure about 15 million more Americans, rather than 30 million. Among other things, the plan would require insurance companies to let people up to age 26 stay on their parents' health plans.
The summit participants noted a handful of areas where the two parties seem largely to agree. They include barring insurers from dropping customers who become sick, ending annual and lifetime monetary limits on health insurance benefits and letting young adults stay on their parents' health policies to their mid-20s or so.
But Republicans stuck to their main talking points. "The American people want us to scrap this bill," said House GOP Leader John Boehner of Ohio, reaching over and touching the massive Senate legislation.
As darkness neared, McConnell also urged Obama to "start over with a blank piece of paper."