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White House, Democrats struggling on health care

THE White House and Democrats are struggling to bring a complex, controversial bill to remake the US health care system - President Barack Obama's top domestic priority - to a vote in both houses of Congress before lawmakers leave town for their August break.

In a potential setback to their efforts, Congress' budget umpire warned yesterday that their health care bills won't meet Obama's goal of slowing the ruinous rise of medical costs, giving weight to critics who say the legislation could break the bank.

Meanwhile, a bipartisan group of senators said they wanted time beyond the president's early August deadline to pursue an agreement.

Slowing the rate of growth for health care spending is one of Obama's twin goals, alongside expanding health care to the 50 million people who now lack it, in the only developed nation that does not have a comprehensive national health care plan.

The government provides coverage for the poor and elderly, but most Americans rely on private insurance, usually received through their employers. With unemployment rising, many Americans are losing their health insurance when they lose their jobs.

The United States spends about two-and-half times as much on health care as other industrialized countries, but it does no better on life expectancy and other measures than nations that spend far less.

Early today, a key committee, House Ways and Means, voted to approve tax provisions of the House of Representatives version of the bill, which would impose US$544 billion in new taxes over the next decade on families making more than US$350,000 a year. Two other House committees worked on separate parts of a bill that would cost roughly US$1.5 trillion.

The House's Speaker Nancy Pelosi has vowed to pass it by the end of the month. But Democratic Sen. Max Baucus, one of the key senators at work on the issue, said Obama "is not helping us" with his opposition to a new tax on health benefits.

Senate Democratic leaders recently shot down the tax approach, but Baucus, who chairs the Finance Committee, still favors it as a way to pay for a health overhaul.

Douglas Elmendorf, the head of the Congressional Budget Office, Congress' budget watchdog, said of the legislation so far, "We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs."

At its core, the new effort involves a requirement for insurance companies to offer policies to all willing buyers, and bars them from charging higher premiums on the basis of pre-existing medical conditions. Legislation would rely on government subsidies to make insurance more available for lower-income individuals and families, and use tax increases as well as cuts in current government health programs to pick up the cost.

"I will not defend the status quo," Obama said Thursday in New Jersey, where he used a political fundraising appearance for Gov. Jon Corzine to make his latest plea for congressional action.
Elmendorf's remarks gave ammunition to Republican critics of the bill. Senate Republican leader Mitch McConnell said the budget director's warning should be "a wake-up call."

Yet there was good news for Pelosi and the administration in hearing rooms not far away.

Republicans on the House Education and Labor Committee failed on party-line votes to delete major portions of the bill, including provisions for the government to offer insurance coverage and create a new way of shopping for health plans through a purchasing exchange.

Republicans were no more successful in the House Ways and Means Committee, where Democrats shot down amendments to eliminate the government insurance option and delete requirements for employers to provide health care. Republicans also failed on amendments to limit medical malpractice awards, and to prevent the government insurance plan from covering abortions. All the votes were largely along party lines.


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