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<H1>Health overhaul closer than ever — and yet far off</H1>
<DIV class=byline><CITE class=vcard>By RICARDO ALONSO-ZALDIVAR, Associated Press
Writer </CITE><ABBR class=recenttimedate
title=2009-10-02T14:24:27-0700>18 mins ago</ABBR> </DIV><!-- end .byline -->
<DIV class="mod ad darla_ad" id=darla-ad__LREC> </DIV>
<DIV class="mod ad darla_ad">WASHINGTON – Eight months in office, <SPAN
class=yshortcuts id=lw_1254519669_0>Barack Obama</SPAN> has now pushed closer
than any other president in generations to creating a <SPAN class=yshortcuts
id=lw_1254519669_1>basic health care</SPAN> safety net for working Americans.
Yet the fate of legislation delivering on his goal is far from certain:
Republicans are nearly unified in opposition, Democrats hardly united in
support.</DIV>
<P>Indeed, few if any of the major arguments about the scope and costs of the
historic undertaking are settled as congressional leaders prepare to take
legislation to the floor in the next two weeks.</P>
<P>Democrats on the <SPAN class=yshortcuts id=lw_1254519669_2>Senate Finance
Committee</SPAN> came together early Friday — after 2 a.m. — to finish the heavy
lifting on a bill designed to appeal to moderates. Obama hailed it as a
milestone and noted, for history, that overhauling health care has eluded
presidents from <SPAN class=yshortcuts id=lw_1254519669_3>Harry S. Truman</SPAN>
to <SPAN class=yshortcuts id=lw_1254519669_4>Richard Nixon</SPAN> to <SPAN
class=yshortcuts id=lw_1254519669_5>Bill Clinton</SPAN>.</P>
<P>"We are now closer than ever before to finally passing reform that will offer
security to those who have coverage and affordable insurance to those who
don't," Obama said.</P>
<P><FONT size=4>But not yet. And not for sure.</FONT></P>
<P>The 10-year, $900 billion bill would remake one-sixth of the U.S. economy,
clearing a path to health insurance for millions who don't have it now. It would
be financed by reducing Medicare and Medicaid payments to <SPAN class=yshortcuts
id=lw_1254519669_6>health care providers</SPAN>, and by ordering new taxes and
fees that are already meeting resistance. Insurers would no longer be able to
turn away those in poor health.</P>
<P>Final passage in the <SPAN class=yshortcuts id=lw_1254519669_7>Finance
Committee</SPAN>, a political bellwether, is all but assured next week. After
that, things really start to get interesting.</P>
<P>Senate Democratic leaders will begin tugging on <SPAN class=yshortcuts
id=lw_1254519669_8>Finance Chairman Max Baucus</SPAN>' hard-won compromise to
try to meld it with a liberal-leaning version passed by the Senate Health,
Education, Labor and Pensions Committee. That second version would allow the
government to sell insurance in competition with private industry, a highly
controversial issue, while the plan from Baucus, D-Mont., would not.</P>
<P><FONT size=5><U>The government-run plan doesn't appear to have the votes to
clear the Senate. <SPAN class=yshortcuts id=lw_1254519669_9>In the House</SPAN>,
it's the other way around</U>. A bill that doesn't include a government plan to
compete with private insurers won't get off the floor, <SPAN class=yshortcuts
id=lw_1254519669_10>Democratic leaders</SPAN> say.</FONT></P>
<P><FONT size=5>That's not the only fault line.</FONT></P>
<P>The <SPAN class=yshortcuts id=lw_1254519669_11>House plan</SPAN> taxes the
wealthy to pay for subsidies needed to make <SPAN class=yshortcuts
id=lw_1254519669_12>health coverage</SPAN> affordable for millions who are now
uninsured. <SPAN class=yshortcuts id=lw_1254519669_13>The Senate</SPAN> instead
taxes the health care haves — those with expensive insurance plans.</P>
<P>The House plan — and the Senate health committee bill — would require
employers to offer coverage to their workers or pay a tax penalty. The Senate
Finance bill has no requirement that employers offer coverage, although it would
levy a charge on businesses whose workers end up getting <SPAN class=yshortcuts
id=lw_1254519669_14>government subsidies</SPAN>.</P>
<P><FONT size=5>If lawmakers manage to work their way through those issues, they
still won't be safely through the political minefield. <U>They'll face
contentious issues including how to deal with coverage for abortions and how to
keep benefits from going to illegal immigrants</U>.</FONT></P>
<P><FONT size=5>"A lot of people have a lot of non-starters, and they are
different non-starters," said <SPAN class=yshortcuts id=lw_1254519669_15>House
Majority Leader Steny Hoyer</SPAN>, D-Md. "<U>If you add up all the
non-starters, it makes it very difficult to pass a bill</U>. When we get an
agreement in the House, it will contain things some people will prefer weren't
in there. It will also contain things they want. As in every major piece of
legislation, you have to find a balance."</FONT></P>
<P>Increasingly, Obama will have to step in to settle disputes and keep the bill
moving forward. That will please some lawmakers and alienate others. He can't
afford to lose many of his fractious Democrats.</P>
<P>Polls show the public has many concerns and questions about the legislation.
But for now, most Americans seem to want Congress to keep working.</P>
<P>Republicans are certain that the more people learn, the less they'll like
about the Democrats' approach.</P>
<P>"What we know for sure about this proposal, the core of it will include half
a trillion dollars in Medicare cuts over 10 years and hundreds of billions of
dollars in tax increases on both individuals and businesses," <SPAN
class=yshortcuts id=lw_1254519669_16>Senate Republican leader Mitch
McConnell</SPAN> of Kentucky told reporters Friday.
<P><FONT size=5><SPAN class=yshortcuts id=lw_1254519669_17>Senate Majority
Leader Harry Reid</SPAN> of <SPAN class=yshortcuts
id=lw_1254519669_18>Nevada</SPAN> has said he wants meld the Finance and health
committee bills in fairly short order. He could have a bill on the floor the
week after next, with <U>debate expected to last for weeks</U>. <SPAN
class=yshortcuts id=lw_1254519669_19>The Democrats</SPAN> have 60 votes in the
Senate — 58 from their party and two independents — and that's the magic number
needed to overcome roadblocks. <U>But as yet there's no bill that 60 Democrats
would agree to</U>. </FONT>
<P><SPAN class=yshortcuts id=lw_1254519669_20>In the House</SPAN>, the third
week of October is the earliest a bill could come to the floor, Hoyer said.
Leaders are still meeting with rank-and-file Democrats to work through
disagreements.
<P>On Friday, more than 100 Democrats sent <SPAN class=yshortcuts
id=lw_1254519669_21>House Speaker Nancy Pelosi</SPAN>, D-Calif., a letter
opposing the tax on <SPAN class=yshortcuts id=lw_1254519669_22>high cost
insurance</SPAN> in the Senate Finance plan. They argued the tax would
ultimately be paid by middle-class union members who bargained hard for
comprehensive health plans.
<P>"The purpose of this letter is to put a big red flag in front of the White
House and the congressional leadership," said <SPAN class=yshortcuts
id=lw_1254519669_23>Rep. Joe Courtney</SPAN>, D-Conn., who circulated the
letter. "This will be a problem."
<P>Finance Democrats have felt the pushback already. Baucus accepted an
amendment by Sen. <SPAN class=yshortcuts id=lw_1254519669_24>Jay
Rockefeller</SPAN>, D-W.Va., that would ease the bite of the insurance tax on
retirees over the age of 55 and for plans that cover workers in high-risk jobs
like coal mining.
<P>Still, the wrangling obscures considerable agreement on what the <SPAN
class=yshortcuts id=lw_1254519669_25>health care system</SPAN> would look like
after it's reengineered. Some of the outlines have emerged:
<P>• Although government will play a bigger role than it does now, most people
will still be covered by private insurance plans sponsored by their employers.
<P>• Medicaid will be expanded to cover more low-income people, including
childless adults for the first time.
<P>• Self-employed people and those working for a company that doesn't provide
health insurance will be able to buy coverage through new insurance purchasing
pools called exchanges. Government would provide <SPAN class=yshortcuts
id=lw_1254519669_26>tax credits</SPAN> for many middle class people. Insurers
participating in the exchanges will have to take all applicants and will be
limited in what they can charge those who are older and sicker.
<P>• Medicare would adopt a new philosophy geared to better coordinating care
for seniors with <SPAN class=yshortcuts id=lw_1254519669_27>chronic
illnesses</SPAN> and trying to keep them out of the hospital.
<P><FONT size=4>Even Democrats who are upset with the Senate Finance bill say
they're optimistic that Congress can get legislation to Obama. </FONT>
<P><FONT size=5>"There is enough momentum now that I would disagree with the
characterization that it's going to be impossible to meld the two sides," said
Courtney, the Connecticut Democrat trying to derail the insurance tax. "<U>My
hope is it will be by Thanksgiving, and my honest opinion is closer to
Christmas</U>." </FONT>
<P>___
<P>Associated Press Writers Erica Werner and David Espo contributed to this
report.</P></FONT></DIV></BODY>
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