McConnell's Republicans, unanimously opposed to Democratic-drafted legislation in the House, are watching warily while three members of their rank-and-file negotiate over a bipartisan plan in the Senate that could hand President Barack Obama a victory on his top domestic priority.
Across the Capitol, the House Energy and Commerce Committee plowed methodically through a stack of proposed changes to the bill, one day after the White House, Democratic leaders and a band of conservative party members reached a compromise to clear the measure.
Chairman Henry Waxman, D-Calif., presiding over the session, warned lawmakers against offering amendments that make the bill more expensive -- and agreed to a Republican suggestion to limit the time allowed for debate. He said he hopes to finish the bill sometime Friday, and House leaders have promised to bring it up for a vote in the full House in September, after the congressional August break.
Speaker Nancy Pelosi expressed confidence the committee would approve the bill, and said the full House would follow suit in the fall. She also signaled flexibility on key issues, saying that despite her own backing for abortion rights, she would not allow the issue to torpedo legislation.
Waxman's shaky majority was on display early, when the committee voted 29-28 to defeat a Republican amendment to strengthen ID requirements designed to prevent illegal immigrants from getting Medicaid benefits.
Another controversial Republican amendment passed by voice vote, over Waxman's objections. Backed by Rep. Mike Rogers, R-Mich., it would bar the federal government from using research comparing medical treatments' effectiveness to deny or ration care.
Already, Congress is running behind a timetable set by its leaders and the White House for a health care bill, and one veteran senator warned of additional slippage.
"The president wanted to have it on his desk in October," said Sen. Tom Harkin, D-Iowa. "He'll probably have it in November now. But I'm very hopeful we'll get it done at least by that time."
Senior aides and lawmakers said privately they thought Harkin was being overly optimistic, and warned of work spreading late into December on the highly controversial issue.
Sen. Mike Enzi, R-Wyo., one of six lawmakers involved in bipartisan talks, said the legislation wasn't "ready for prime time."
The House bill and the plan under negotiation in the Senate are designed to meet Obama's goals of spreading health coverage to millions who now lack it, while trying to slow the skyrocketing growth in medical costs.
Wednesday in the House, Democratic leaders gave in -- at least temporarily -- to numerous demands from rank-and-file rebels from the conservative wing of the party. The so-called Blue Dog Democrats had been blocking the bill's passage in Energy and Commerce.
The House changes, which drew immediate opposition from liberal lawmakers, would steer away from using Medicare as the blueprint for a proposed government insurance option, reduce federal subsidies to help lower-income families afford coverage, and exempt additional businesses from a requirement to offer health insurance to their workers.
Rep. Mike Ross of Arkansas, a leader of the Blue Dogs, said the changes agreed to by the leadership in the House bill would cut its cost by about $100 billion over 10 years. But his claim has been called into question.
A new break for small businesses, among other changes in the deal, also increased costs substantially, so it wasn't clear that the agreement actually generated net savings.
Waxman said the cost of helping small businesses was offset by a reduction in the level of federal subsidies that would be available to help people buy health insurance. The net result appeared to be a wash.
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