WASHINGTON — Democratic leaders in Congress launched a final round of health care talks Tuesday, pledging to overcome their remaining differences with the aim of sending a bill to President Barack Obama before his State of the Union address in late January or early February.
The legislative overhaul of the nation’s health care system stands closer to enactment than any similar effort in nearly 100 years. But before Democrats can claim victory, major policy gaps must be bridged.
Among them: The House’s version of the bill would create a federally funded insurance option, while the Senate’s would not; and the House would create a national insurance exchange, while the Senate would take a state-by- state approach to such a marketplace.
Congressional negotiators have little room to maneuver, given the narrow margins of support for the legislation in both chambers. Conservative and liberal Democrats are wary that the bill will shift too much away from their positions.
The public insurance option remains a top priority for liberals, but Senate Majority Leader Harry Reid, D-Nev., tried and failed before Christmas to secure the 60 votes needed in that chamber to support such a plan.
Speaking to reporters Tuesday, House Speaker Nancy Pelosi, D-Calif., suggested that a public option isn’t the only way to guarantee competition and affordable premiums.
“There are other ways to do that, and we look forward to having those discussions as we reconcile the bill,” she said.
Party leaders have not settled on a process for that reconciliation.
Last month, Democratic leaders began weighing a fast-track alternative to the traditional House-Senate conference committee. The informal approach would still require the House and the Senate to pass identical bills but would minimize the opportunity for Senate Republicans — who united in opposition to the bill — to slow the process.
Republicans decried the idea as a breach of Obama’s transparency pledge, while some House liberals objected to losing the public forum that a conference committee would provide.
Even C-SPAN, the cable-television network devoted to public-affairs programming, complained about the possibility of a closed-door finale to a process destined to “affect the lives of every single American,” as Brian P. Lamb, the network’s chairman, wrote to House and Senate leaders Dec. 30.
Pelosi told reporters Tuesday that “no decision” had been made about a conference committee. And one of her leadership deputies, Rep.Chris Van Hollen, D-Md., said of the fast-track approach, “It’s not clear whether or not that’s going to happen yet.”
White House spokesman Robert Gibbs defended the idea. “The president is anxious to get the differences worked out and get a bill to both houses and passed out of them,” he said Tuesday at the daily White House press briefing.
Whatever the format, House and Senate negotiators are expected to hold daily meetings and conference calls for the duration.
