Health-Care Bill Faces Delay as Democrats Struggle With CBO

Congressional Democrats, racing to finish work on an overhaul of the U.S. health system, are facing delays as they strive to meet deficit-cutting targets.

The Democrats, who had expected a final cost estimate from the Congressional Budget Office as early as last week, have to show that a bill amending legislation the Senate passed in December will reduce the federal budget deficit by $2 billion over the first five years and not add to the deficit afterward.

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House Speaker Nancy Pelosi said she also wants the two measures together to cut the deficit by $100 billion over the first decade and $1 trillion over the second decade.

“The numbers have to add up to drastic deficit reduction,” Pelosi, a California Democrat, told reporters yesterday. She later said the House would meet the budget targets, and party leaders including House Majority Leader Steny Hoyer reiterated that they expect a vote this week.

Still, Pelosi and Senate Majority Leader Harry Reid can’t move forward until they have the cost estimate from the nonpartisan budget office. They have been going back and forth with CBO officials for days, Reid said.

“It’s not as if CBO has been over there waiting to crank up their adding machines,” Reid told reporters. “They’ve been giving us numbers all along, trying to come up with a final product. And we expect that soon.”

Deadline Looms

Lawmakers are trying to complete their votes before they leave Washington for a two-week recess on March 26. President Barack Obama is pushing for action to cover tens of millions of uninsured Americans without adding to the deficit. The president is keeping the pressure on, lobbying undecided lawmakers and planning a health-care speech in Fairfax, Virginia, on March 19, his fourth in two weeks.

The plan calls for the biggest health-care changes in four decades. Americans would be required to get insurance, with subsidies and purchasing exchanges to help. Insurers such as Indianapolis-based WellPoint Inc. would get millions of new policyholders and be required to accept all customers.

Health insurance stocks rose yesterday after two days of declines. The Standard & Poor’s 500 Managed Health Care Index climbed 1.3 percent, led by a 3 percent gain for Bethesda, Maryland-based Coventry Health Care Inc.

Republican Opposition

Democrats are trying to pass the legislation over the unanimous opposition of Republicans and polls that show public opinion against them.

The House has to approve the $875 billion bill passed by the Senate and clear a set of changes to that measure through a budget process called reconciliation. The changes are needed because House Democrats object to parts of the Senate bill. The Senate would then pass the reconciliation bill.

Among the issues House leaders and the CBO are discussing are the size of subsidies for middle- and low-income families; changes to the Medicare payroll tax; the amount of funding states get for Medicaid programs for the poor and disabled, and payments to doctors who take Medicaid patients, said Ron Pollack, executive director of Families USA, a Washington-based group that advocates for health legislation.

Another key area is the provision affecting the so-called “doughnut hole,” a gap in coverage for seniors’ prescription- drug benefits under Medicare, Pollack said.

“If CBO has a cost score that is higher than is anticipated, you can dial down,” Pollack said. “If CBO delivers greater cost savings than expected, you can dial up.” He added, “none of this should be the source of a crisis.”

Skipping the Vote

At the same time, Pelosi is considering how to win votes. One option is trying to shield her members from a vote on the Senate bill by using a mechanism that would “deem” the legislation passed without a full vote, a possibility that has drawn fire from Republicans.

“There are a lot of people who don’t want to vote for it,” she said yesterday. “We will do what is necessary to pass a health-care bill.”

Senate Republican leader Mitch McConnell said Democrats had “concocted a way to pass it without actually casting a vote.” He said Pelosi was trying “to pull the wool over the eyes of the public,” in a speech on the Senate floor.

Pelosi responded, “If you don’t want to talk about substance, talk about process.”

While she voiced optimism about the legislation’s prospects, she has a number of hurdles.

Tax on Benefits

House Democrats are especially focused on changing one aspect of the Senate bill, an excise tax on high-end insurance policies. They say the levy, opposed by labor unions, would affect too many workers and want to scale it back.

New Hampshire Senator Judd Gregg, the ranking Republican on the Senate Budget Committee, said Democrats may not be able to reduce the tax through a reconciliation bill because it might affect revenue flowing into Social Security.

“Anything that affects Social Security cannot be done,” Gregg said.

Senate Budget Committee Chairman Kent Conrad, a North Dakota Democrat, said Democrats could make it work.

“Many of these things depend on how it’s written,” Conrad said. “Could it be written in a way that would be stricken? Sure. I don’t think that will happen.”