House divided on health care

WASHINGTON -- House Democrats put their divisions on display over the details and timing of health care legislation Tuesday, despite attempts by President Obama to hasten a compromise on the issue that looms as a major test of his clout.

With a self-imposed deadline for action in jeopardy, the Democratic leadership juggled complaints from conservatives demanding additional cost savings, first-term lawmakers upset with proposed tax increases and objections from members of the rank-and-file opposed to allowing the government to sell insurance in competition with private industry.

"No one wants to tell the speaker that she's moving too fast and they damn sure don't want to tell the president," Rep. Charles Rangel, D-N.Y., a key committee chairman, told a fellow lawmaker as the two walked into a closed-door meeting. The remark was overheard by reporters.

Speaker Nancy Pelosi, D-Calif., vowed weeks ago that the House would vote by the end of July on legislation to meet two goals established by Obama months ago. The president wants legislation to extend health coverage to the tens of millions who now lack it, at the same time it restrains the growth in the cost of health care far into the future.

The president also has vowed that the legislation will not swell the deficit, although a senior administration official said Tuesday the pledge does not apply to an estimated $245 billion to increase fees for doctors serving Medicare patients over the next decade.

Peter Orszag, the White House budget director, said that was because the administration always assumed the money would be spent to avert a scheduled cut of 21 percent in doctor's fees.

In the Senate, a small group of bipartisan lawmakers met behind closed doors, pursuing a so-far elusive agreement.

Sen. Olympia Snowe, R-Maine, described the process as a grinding one. "Basically, it's filling in the blank pages. There are about a thousand" of them, she said.

Increasingly, it appeared that the best Democrats could hope for this summer would be a vote in the full House by the end of the month, and some sort of agreement on a bipartisan plan in the Senate before lawmakers head home for their summer vacation.

Even that remained a difficult challenge, though.

"If we can get to consensus, we're going to move," said House Majority Leader Steny Hoyer, D-Md. "If we can't get to consensus, we're going to continue to work on creating consensus."

At the White House, Obama clearly had Republicans in mind, not Democrats, when he demanded action.

"So I understand that some will try to delay action until the special interests can kill it while others will simply focus on scoring political points," the president said. "We've done that before. And we can choose to follow that playbook again, and then we'll never get over the goal line and will face an even greater crisis in the years to come."

He said that despite the controversy, months of debate have produced agreement on numerous health care issues, and he summoned lawmakers to complete the work.

"When we do pass this bill, history won't record the demands for endless delay or endless debates in the news cycle. It will record the hard work done by the members of Congress to pass the bill and the fact that the people who sent us here to Washington insisted upon change," he said.

Obama has spoken in public nearly every day for more than a week on the issue, some times more than once. At the same time Republicans have upped the political stakes.

On Monday, Michael Steele, the Republican chairman, likened Obama's proposals on health care to socialism, and said the chief executive wanted to conduct a "risky experiment" that will damage the nation's economy and force millions to lose the coverage they now have.

Last week, Sen. Jim DeMint, R-S.C., was quoted as telling fellow conservatives, "If we're able to stop Obama on this, it will be his Waterloo. It will break him," a reference to the site of French Emperor Napoleon's defeat in 1815.

Given the struggle, the polls show slippage for Obama, although he remains popular.

Still, with details unsettled and Democrats in disagreement, the president is battling the impression if not the reality that his proposal is stalled.

He met at the White House during the day with so-called Blue Dogs, moderate and conservative Democrats whose call for additional cost savings has slowed work in the House Energy and Commerce Committee. The panel is the only one of three that has yet to approve its portion of the legislation.

Separately, nearly two dozen first-term lawmakers have called for changes in tax increases in the legislation that would apply to individuals making more than $280,000 a year and couples over $350,000.

Pelosi said on Monday she favored a change so the tax wouldn't take effect until income reached $500,000, a statement that cheered Rep. Jared Polis, D-Colo., one of the lawmakers who had expressed concern.

But Rangel told reporters that neither Pelosi nor the rank-and-file critics have spoken with him about the suggested change. "I support what we have put out. If anybody has a problem with it I'm anxious to listen to it," he added.

In a measure of the complexity of the task, Orszag said conservative Democrats had reacted favorably to proposals to create an independent commission to recommend future increases in health care provider payments under Medicare.

It is one of only a few proposals in circulation that officials say has the ability to restrain the skyrocketing growth of health care costs.

But accepting such a proposal would require lawmakers to surrender their current power to set fees, which they can adjust to favor constituents.

"I think that we always need to be reminded that members of Congress don't serve under presidents, they serve with presidents," said Rep. Richard Neal, D-Mass.

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Associated Press writers Ricardo Alonso-Zaldivar, Erica Werner, Charles Babington and Ben Feller contributed to this story.