WASHINGTON — Congress will return Tuesday from a hot August recess to a politically steamy September, when lawmakers will resume grappling with crafting a comprehensive health care bill as Democrats try to mend rifts within their ranks over its scope and cost.
After enduring a month of often-confrontational questions at town hall meetings in their districts and fearful of suffering loses in next year's midterm elections, Democrats in the House of Representatives and the Senate are hoping that returning to work will help them regain control of the health care debate.
"Having gone through the aborted 1994 health care campaign, I fully expected what happened to us in August happening," Rep. Eliot Engel, D-N.Y., said of the testy town hall sessions. "Now we have to go on the offensive."
That will begin quickly. President Barack Obama will meet Tuesday afternoon with House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev. Caucuses of Democratic lawmakers are expected to meet privately Tuesday and Wednesday. Last, Obama will address a joint session of Congress on Wednesday night, and White House aides say he'll try to take command of the debate by specifying more of what he wants.
Rep. Xavier Becerra of California, the House Democratic Caucus vice chairman, spoke with Obama last week, and said that the president emphasized two goals: reducing the cost of insurance for those who have it and increasing the number of insured people.
Obama didn't specify then what he'd support, however.
"He just said, 'Get it done,' " Becerra said.
That's easier said than done. House Democrats, who control 256 of the chamber's 435 seats, remain as divided as they were before the recess.
Liberal Democrats such as Engel say that a bill must include a "public option," which would create a government-run program to compete with private insurers to drive down the price of insurance.
However, the 52 members of the conservative Blue Dog Democratic caucus, who generally face tough re-election fights, balk at the sweeping legislation that three House committees have passed so far. They especially question the price tag, which the nonpartisan Congressional Budget Office has assessed at about $1 trillion over 10 years.
At the same time, some 80 liberal House Democrats have threatened to oppose any legislation that doesn't include a public option.
"It's a delicate balance," Engel said. "Where do you get the Blue Dog votes without losing the progressives?"
After Obama speaks, House Democrats will try to meld the three measures drafted by the Energy and Commerce, Ways and Means, and Education and Labor committees into a single bill.
Staff members expect to have about 85 percent of a final bill ready, but House leaders won't settle on final terms until they've heard their members report at their caucus about what they learned back home in August.
The public-option part of the bill is likely to remain unchanged, House leadership aides said. They also anticipate that the final bill will create health exchanges, or marketplaces, in which consumers can shop for insurance policies.
The terms in the draft legislation that are most likely to see some changes are provisions that affect small business and some tax increases.
The draft House legislation would begin imposing surcharges on families that earn $350,000 annually or more.
Businesses with payrolls of less than $500,000 would be exempt from having to provide health insurance coverage. Those with payrolls of $500,000 to $750,000 would have to provide partial coverage, and businesses larger than that would be subject to penalties if they didn't provide coverage. A new small-business tax credit would be created to help firms that wanted to provide coverage.
Some Blue Dogs balk at those provisions, but others are willing to go along; the exemption threshold was raised in late July during Energy and Commerce deliberations, enough to win some Blue Dog votes.
Rep. Mike Ross, D-Ark., a Blue Dog leader, was satisfied.
"Far from undermining small businesses, the bill would significantly cut the costs of health care coverage for small businesses, thereby reducing the cost of doing business for many small business owners and allowing them to help their employees while saving and creating jobs," he said.
Rep. Chris Van Hollen, D-Md., assistant to Pelosi, said that everyone had to compromise. The tax increases, he said, are "the least bad of bad choices" and would raise taxes on people "who got a big break during the Bush administration."
Pelosi intends for the House to approve legislation this month.
In the Senate, three unfolding dynamics should guide the action.
- Senate Finance Committee. Six negotiators, three from each party, have been talking since June, seeking common ground.
It hasn't gone well lately. Earlier this week, a fundraising letter surfaced from Sen. Charles Grassley, R-Iowa, one of the six, reminding supporters of "my firm and unwavering opposition to government-run health care."
He asked for "your immediate support in helping me defeat 'Obama-care.' "
Last Saturday, Sen. Michael Enzi of Wyoming, another of the six, delivered the Republican Party's weekly radio address at roughly the same time that mourners were gathering in Boston for Sen. Edward Kennedy's funeral Mass.
There Obama recalled Kennedy's lifelong fight for health care laws, even as Enzi charged that "the Democrats are trying to rush a bill through the process that will actually make our nation's finances sicker without saving you money."
The third Republican, Olympia Snowe of Maine, is floating a compromise that the White House is weighing, according to The Wall Street Journal. Under it, individuals would have to buy insurance off a federal exchange, with tax credits to help people afford it. If that failed to lower insurance prices and to expand coverage to 95 percent of a state's population within a certain time, the plan would add a government insurance option to that state's choices.
The six were to talk again Friday, and Senate Finance Committee Chairman Max Baucus, D-Mont., said he still hoped that a deal could be reached by mid-September.
- The Kennedy legacy. Democrats invoke his name incessantly as inspiration for their cause.
"We need affordable, accessible, quality health care. We all share the same principles," said Sen. Christopher Dodd, D-Conn. He's a close Kennedy friend who could take the late senator's place as the chairman of the Senate health committee, which has approved a health care bill similar to the House Democrats' version. "How you get there is complicated, but that's what Senator Kennedy dedicated his life to. I'm dedicated to it.
"And in his memory, I will do everything I can — as long as I can stand in the United States Senate — to help us achieve that goal."
- Senate rules change. Under a rule adopted earlier this year, senators can move certain parts of health care legislation with only a simple majority of 51 votes; they control 59 votes in the 99-member body. Usually 60 votes are required under Senate rules to break a filibuster.
Would Democrats dare, however, to pass a measure as sweeping and controversial as a health care overhaul with such raw partisan tactics a year before they face elections?
Republicans already are howling.
"There would be a minor revolution in this country," said Senate Republican Conference Chairman Lamar Alexander, R-Tenn.
Once the legislation passes the House and the Senate, the two versions will have to be reconciled in a House-Senate conference committee that could rewrite the bill top to bottom. That's when Obama and the Democratic leadership of both houses are expected to weigh in heavily. They'll hammer out a final Democratic measure and put their party's legacy behind its passage, which is unlikely before November.
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