WASHINGTON — The White House and congressional negotiators made significant progress Wednesday toward cobbling together health care legislation, reaching agreement with rebellious Democratic centrists and inching closer to an accord with key Senate Republicans.
The day saw a major breakthrough in the House of Representatives, as four Democratic moderates, whose support is crucial to the health care effort's progress, brokered a pact with their party's liberal leaders that they said would cut $100 billion from the leaders' plan.
In the Senate, six negotiators, three from each party, said they'd agreed tentatively on a number of key elements as they continued to seek a centrist alternative to the liberals' plan. The most notable one would replace the "public option" — the government-run insurance program that President Barack Obama and liberals wanted — with a system of "co-ops," or member-owned nonprofit groups much like rural electric utilities, which could compete with private health insurers regionally.
"We're almost there," said negotiator Sen. Charles Grassley, R-Iowa.
The legislation still faces a long road ahead. Two congressional committees must approve versions of the bills _both are expected to do so by the end of next week _and then both full chambers must vote. That won't happen in either the House or Senate until after Congress' annual August recess.
If each chamber passes some version of the legislation then, negotiators from each house will have to combine the bills into a single final version. Then both houses must vote again on that. Those votes are unlikely before late autumn.
The journey will require overcoming lots of hurdles, and one of the first involved the Democratic "Blue Dogs," 52 conservatives and moderates who balked at the cost and scope of the plan that liberal Democrats drafted.
After six hours of talks among them, House Democratic leaders and administration officials led by White House Chief of Staff Rahm Emanuel, the Blue Dogs were assured that no floor votes would be taken on the legislation until after Congress returns from its summer recess on Sept. 8.
While that gives them time to explain the plan to skeptical constituents, it also gives interest groups an extra month to run ads and mount grass-roots campaigns for and against the health care overhaul.
House leaders said they weren't concerned.
"In September," said a joint statement by House Speaker Nancy Pelosi, D-Calif., and Majority Leader Steny Hoyer, D-Md., "Congress will pass legislation that puts Americans and their doctors back in charge, holds insurance companies accountable, guarantees stability and peace of mind, lowers costs and provides more choices for higher quality care."
Obama had said as recently as July 15 that he hoped for floor votes in the House and Senate before the recess. Wednesday, he offered only praise for the incremental progress, thanking the Blue Dogs for "working so hard to find common ground. Those efforts are extraordinarily constructive in strengthening this legislation and bringing down its cost."
The six centrist Senate negotiators, all members of the Finance Committee, claimed progress not only on endorsing co-ops instead of the "public option" but also said they were close to removing any requirement that employers provide health insurance and to imposing taxes on insurers who offer expensive policies.
Finance Committee Chairman Max Baucus, D-Mont., also was cheered by an estimate from the nonpartisan Congressional Budget Office that showed that the negotiators' still-evolving plan would cost about $900 billion over 10 years — less than previous estimates — and cover 95 percent of Americans within six years.
While the six Senate negotiators hope to reach final agreement soon so that the full committee can consider the measure next week, they still face hard bargaining.
Negotiator Olympia Snowe, R-Maine, warned, "It's hard to say what's in or out until it's all written out completely."
Crafting such legislation is a delicate balancing act. A spending plan may depend on agreement on a funding plan, for instance; should one part not win consensus, the entire initiative could fail.
As a result, Grassley said, the risk of collapse is always present. "These are tough issues we're dealing with," he said.
The mood in both chambers of Congress, though, was decidedly more upbeat Wednesday.
In the House, Rep. Mike Ross, D-Ark., the chairman of the Blue Dog Health Care Task Force, praised his colleagues' deal, saying that "it protects small businesses and it saves our rural hospitals and ensures that if there is a public option, it will be just that."
The deal adjusts the "public option" — the government-run insurance program that would compete with private insurers under the liberals' plan — by allowing physicians and other health care providers to negotiate rates with the government plan. It also would exempt an estimated 86 percent of small businesses from any government mandate requiring them to provide employees with health insurance. Businesses with payrolls below $500,000 would face no mandate.
The bill had been stuck in the House Energy and Commerce Committee, which has been struggling all week to write legislation. While the committee has 36 Democrats, seven Blue Dogs were balking at the liberals' bill.
"We came to the table wanting to squeeze out costs," Ross said. "We came out understanding that we have."
Four of the committee's Blue Dogs — Ross and Reps. Baron Hill of Indiana, Bart Gordon of Tennessee and Zack Space of Ohio — agreed to the plan.
The three others didn't, however, including Rep. Charlie Melancon of Louisiana, the Blue Dogs' communications co-chairman.
"The bill doesn't generally get to where I feel comfortable," he said. "There are still a whole lot of things I need to understand."
The deal by the four Blue Dogs took Republicans by surprise. At a lunch with reporters before the agreement, House Republican leader John Boehner of Ohio praised the Blue Dogs, saying "good for them" for defying their leadership.
A few hours later, his mood had changed. The agreement, he said, "proves once again that the so-called Blue Dogs have no bite when they're forced to choose between their constituents and the radical leadership of their party."
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