WASHINGTON -- Democratic leaders Thursday invoked the spirit of generations of party heroes to rally their members of the House of Representatives behind a new health care plan -- but it's clear that winning a majority will be a tough fight.
House Speaker Nancy Pelosi, D-Calif., unveiled a 1,990-page bill at an elaborate ceremony on the west front of the Capitol, reminding supporters that Sen. Edward Kennedy, the Massachusetts Democrat who died in August, "made this his life work." Other speakers recalled the efforts of Harry Truman and Franklin Roosevelt.
However, it was telling that of the 100-odd lawmakers surrounding Pelosi, few if any belonged to the conservative, 52-member Blue Dog Democratic coalition. They'll be crucial to her bill's success.
Still, House Democratic Caucus Chairman John Larson, D-Conn., said flatly: "We've got 218," the number of votes needed for passage. The House, which has 256 Democrats, 177 Republicans and two vacancies, is expected to debate the bill next week. No Republicans are expected to support the bill.
Many Blue Dogs aren't yet ready to join their party's liberal leaders.
"The plan on the table has some good points and some bad points. I want to look at it," said Rep. Lincoln Davis, D-Tenn.
Blue Dogs wanted to hear from constituents, many of whom are more conservative than those represented by most Democrats. "I have both sides of the health care debate well-represented in my district," said Rep. Allen Boyd, D-Fla.
Pelosi melded the new measure from three similar bills passed last summer by three House committees. The bill's centerpiece is a government-run insurance program, or public option, that would compete with private insurance and offer coverage to those who have trouble getting private plans.
The measure, similar to the pending Senate Democratic health care plan, would create an "exchange," or marketplace, where consumers could shop for insurance plans and rates. Lower income people would get financial help for coverage.
The Congressional Budget Office estimates the Pelosi plan's cost at $894 billion over 10 years, with the federal budget deficit shrinking by $104 billion because of its terms. Much of the funding would come from Medicare savings and a surcharge on adjusted gross incomes above $500,000 for individuals and $1 million for those filing jointly.
Nearly everyone would have to obtain health insurance, and employers would have to offer it or face penalties. The bill would assure that about 96 percent of eligible Americans are covered, up from the current 83 percent.
Blue Dogs and some party moderates have been concerned about the plan's cost, as well as its impact on small business and expansion of government. Those concerns remain.
Rep. Bob Etheridge, D-N.C., who plans to hold a telephone town hall meeting with constituents next Wednesday, wouldn't give a position on the bill, but he's open to the public option idea, said spokesman Don Owens.
"The congressman thinks the public option was proposed to give constituents choice," Owens said. "It's not the only essential choice, but it's one. I think the congressman can get behind any provision that provides choice for constituents and keeps costs down."
Davis of Tennessee said a key concern is that "small business is struggling with this constantly," and he has to be convinced that a new plan would create a system where small employers are treated fairly.
Rep. Gene Taylor, D-Miss., retains questions about its fiscal impact, saying, "We cannot add an expensive new subsidized health care program on top of the huge current debt that is $11 trillion and growing rapidly."
At least one major Blue Dog concession was met: The bill would allow the government to negotiate the public plan's reimbursement rates with doctors, hospitals and other health care providers, instead of tying those fees to Medicare's rates.
"That was the critical element, and it's been successfully resolved," said Rep. Earl Pomeroy, D-N.D. He said that physicians and hospitals in his state say they aren't properly reimbursed by Medicare. He said he could now support the bill.
House Democratic leaders still face other disputes among some of their members, notably over abortion and immigration.
Staunch anti-abortion Democrats want explicit language barring any new sources of federal funding for abortion except in cases of rape, incest or when a woman's life is in danger.
Some were upset this summer when the House Energy and Commerce Committee included a provision in its bill that would permit certain abortion services to be provided, though federal funding would be strictly limited.
There was no clear indication that issue had been resolved Thursday, but Rep. Mike Doyle, D-Pa., who described himself as a "pro-life Democrat," said "dialogue is ongoing, and I can't imagine this will kill comprehensive health care reform."
Immigration could prove thornier. While there's general agreement that illegal aliens should not be eligible for public coverage or government aid, there's controversy about how the government would verify one's immigration status.
Rep. Chris Van Hollen, D-Md., a top Pelosi lieutenant, said that the issue could be resolved. "It will be clear we don't want subsidies going to people who are here illegally," he said.
Democratic leaders voiced confidence that all issues would be resolved in the next few days.
"We'll have the votes necessary to pass this," said Majority Whip Jim Clyburn, D-S.C., "but people have certain emotions we have to work through."
(Barbara Barrett, Halimah Abdullah and Rob Hotakainen contributed to this article.)
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