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Obama Will Add His Weight to Push for Senate Health Care Bill

By Alex Wayne, CQ Staff

December 5, 2009 -- President Obama is heading to the Capitol on Sunday to help Senate Democratic leaders rally their fractious troops behind a compromise version of the health care overhaul bill.

Majority Leader Harry Reid, D-Nev., and his lieutenants have been struggling to put out brushfires ignited by sparks of resistance from the left and right within the 60-member Democratic caucus.

Obama's visit at 2 p.m. Sunday could help quell some of the grumbling and dissent from various factions about what is—or isn't—included in the current version of the legislation (HR 3590).

A core group of negotiators from both wings of the party plans to reassemble after Obama's visit in a bid to seal a deal by the end of the day on one key issue — whether and how to create a public option that would compete with private insurance plans in the exchanges, or marketplaces, that the bill would set up to offer health coverage to uninsured individuals and many small businesses. Liberals hope that Obama will side with them against moderates who are trying to change the public option in ways proponents think would weaken it.

"It's pretty clear where the great majority of Congress is and where the great majority of the country is on this bill," said Sen. Sherrod Brown, D-Ohio, a leading public option proponent. "I just want to see the president speaking out and talking to those members who are a little less enthusiastic to support [the bill]."

In an indication of the trouble Democrats have had corralling votes from their own members, a group of moderates met with Republican Olympia J. Snowe of Maine on Saturday. Snowe aides did not respond to questions about the meeting. She is seen as the likeliest Republican vote for the bill, and Democrats may well need her, as Sen. Ben Nelson, D-Neb., has indicated he will oppose the legislation if its restrictions on insurance coverage for abortion are not tightened.

Liberals insist the best way to force private insurers to offer adequate coverage at affordable premiums is to create a public option that would be offered in competition with private plans. But a handful of moderate Democrats refuse to support all but the most limited and constrained versions of a public option.

A group of 10 senators—five from each camp—began meeting privately Friday evening to discuss a compromise. They met again Saturday, after huddling separately, and Sen. Tom Harkin, D-Iowa, a public option proponent, said the goal is to reach an accord on the issue by Monday.

"Maybe by tomorrow, or maybe Monday, somewhere in there we will have a proposal we can all shake hands on," he said. Reid "is ready for a manager's amendment," Harkin added, referring to a comprehensive amendment to the current bill that would incorporate all the changes negotiators have agreed to support.

Several moderates said the group had discussed some sort of arrangement in which the public option would be run by a nonprofit, rather than the government. By late Saturday, however, senators were describing a system in which the federal Office of Personnel Management would administer a public option system consisting of several national, private nonprofit insurance plans competing with each other. OPM already operates the Federal Employees Health Benefits Plan.

"I think we're pretty well set on OPM," Harkin said. That would represent a concession to moderates, who have been concerned about allowing the Health and Human Services Department to operate an insurance plan while also regulating insurance markets. But the plan would still be administered by the government, something important to liberals.

Harkin also said the public option would be a single, national plan, not several state or regional plans — something else liberals have sought.

He said the group had reached "a general agreement on where we're headed on this thing."

White House health adviser Nancy-Ann DeParle spent most of Saturday at the Capitol, along with Health and Human Services Secretary Kathleen Sebelius. At the end of the day's negotiations, DeParle said she was pleased with their progress.

" It's about where it should be at this point in the legislative process ," DeParle said. She added that the administration still expects the Senate will complete the bill by Christmas.

"We're trying to get to yes with 60 votes in a way that the more liberal members of our caucus and the more conservative members of our caucus can agree on," said Sen. Tom Carper, D-Del.

Abortion, Drug Imports
The public option is not the only issue still to be resolved before Reid can move the Senate toward votes on a manager's amendment and final passage.

Also splitting the caucus is the insistence of anti-abortion senators, led by Nebraska's Nelson, that the legislation be changed to mirror curbs added on the House floor to preclude coverage of abortion with any public funds under the bill. Nelson said Saturday that the amendment he intends to press will be "very similar" to the House language, despite the hopes of some abortion-rights advocates that he would agree to soften it somewhat.

Also looming is a floor fight over an effort by Byron L. Dorgan, D-N.D., and John McCain, R-Ariz., to allow importation of cheaper prescription drugs from abroad—a move that is strongly opposed by brand-name drugmakers and their trade group, the Pharmaceutical Research and Manufacturers Association (PhRMA).

"Sen. Reid has committed to myself and to Sen. McCain that I'll be offering my amendment following the disposition . . . of what I believe will be two amendments on abortion. . . . My expectation is my amendment will come up on Monday afternoon," Dorgan said.

Dorgan's amendment would effectively scrap an informal agreement by the White House to limit the amount of cuts in drug spending required by the bill in order to cement support from PhRMA, which has run an advertising campaign to support completion of the bill.

Dorgan said he had insisted on having a vote quickly, in the hope of seizing momentum from a recent Congressional Budget Office analysis that concluded the proposal would save about $19 billion over 10 years, by prodding manufacturers to lower drug prices in order to compete with drugs reimported form Canada.

White House Role, GOP Criticism
Obama, a former senator (2005-09), has stressed repeatedly the need for compromise. He has been careful not to draw lines in the sand about what he would or would not accept in the legislation, even as he has maintained pressure for action this year.

Although Democratic leaders in Congress originally hoped to have a bill to Obama's desk by year's end, the substantive complexity of the legislation, growing concerns over its cost at a time of record deficits and the delicate political dynamics among Democrats in both chambers have slowed progress. Now, the goal is to win Senate passage before Dec. 31.

The president's diffidence has drawn some criticism from Democrats who want him to weigh in more directly and consistently. But the president has been deferring to Reid on when and how he should get involved.

Administration aides are frequently seen at Reid's office, but it is not clear to what extent they are influencing negotiations.

"I think they're meeting with people," Brown said. "Their fingerprints are on a few things."

Republicans, meanwhile, said they were happy to wait out the Democrats.

"I think the majority leader believes that somehow if we stay in on weekends the Republicans are going to blink," said Minority Leader Mitch McConnell, R-Ky. "And I can assure him we're not going to blink. We'll be here and we'll be voting, and in my view, the longer we discuss this with the American people, the more unpopular it becomes."

— Alan K. Ota and Greg Vadala contributed to this story.

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