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Accord on health care nearer

SATURDAY, JAN. 16, 2010

Massachusetts election for Senate adds impetus

WASHINGTON – President Barack Obama and top congressional Democrats closed in on agreement Friday on cost and coverage issues at the heart of sweeping health care legislation, their marathon White House bargaining sessions given fresh urgency by an unpredictable Massachusetts Senate race.

Rep. Jim Clyburn, D-S.C., the third-ranking House Democrat, said, “Something should be going to CBO very soon.” The Congressional Budget Office is the official arbiter of the cost and extent of coverage that any legislation would provide.

One key obstacle appeared on its way to a resolution when Sen. Ben Nelson, D-Neb., requested the elimination of an intensely controversial, one-of-a-kind federal subsidy to cover the entire cost of a Medicaid expansion in his home state.

In its place, officials said, Obama and lawmakers decided to increase federal money for Medicaid in all 50 states, although it was not clear if there would be enough to cover the expansion completely.

The increase in the Medicaid program is a key element in the bill’s overall goal of expanding health coverage to millions who lack it. The bill also envisions creation of new insurance exchanges, essentially federally regulated marketplaces where consumers can shop for coverage. Individuals and families at lower incomes would receive federal subsidies.

The overhaul legislation also is designed to curb insurance industry practices such as denial of coverage on the basis of pre-existing medical conditions.

At the White House, spokesman Robert Gibbs was unequivocal that Obama’s yearlong campaign for health care legislation would prove successful. “As you heard the president say yesterday, we’re going to get health care done,” he said.

Not everyone was so certain, particularly given poll results from Massachusetts that showed Republican Scott Brown within reach of a possible upset over Democrat Martha Coakley in a three-way race to succeed the late Sen. Edward M. Kennedy.

“If Scott Brown wins, it’ll kill the health bill,” said Rep. Barney Frank, D-Mass, reflecting that the Republican would provide opponents of the health care bill a decisive 41st vote to uphold a filibuster and block passage. Frank predicted Coakley would ultimately win the seat.

The president called on Congress in his inaugural address a year ago to send him legislation that also would slow the rise in health care costs generally. Neither the House- nor the Senate-passed legislation is certain to accomplish that last goal, according to officials at the Centers for Medicare and Medicaid, a federal agency, and it appeared the White House might be trying to redefine its terms.

The talks at the White House proceeded in private – a distinct contrast, Republicans pointed out, to Obama’s 2008 campaign pledge to have final negotiations televised on C-SPAN.

The principal source of funding for the legislation is to be a series of cuts in projected federal payments to Medicare providers such as hospitals and nursing homes. Insurance companies that sell private Medicare coverage would take the brunt of the impact.

Additionally, union leaders signed off Thursday on a tax on high-cost insurance plans, and a Senate-passed increase in the payroll tax on incomes of more than $200,000 for individuals and $250,000 for couples was likely to be expanded, possibly to apply to investment earnings.

Even with an agreement on cost and coverage, Democrats would have to resolve controversy over abortion, coverage of immigrants and other issues before sealing a final compromise.


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