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With President Barack Obama’s political fortunes on the line, Democrats in Congress vowed on Monday to push healthcare reform through the Senate with or without Republican support.
"No matter what happens we are going to enact healthcare reform by the end of the year," said Senator Charles Schumer, one of the Democrats who has been working with Republicans to craft a bipartisan plan in that chamber.
Obama has made overhaul of the $2.5 trillion healthcare system this year his top domestic priority, saying it is central to long-term economic recovery, and its success or failure could define his presidency.
Obama and the Democrats who control Congress say now is the time to move on healthcare, before lawmakers become entangled in fighting for their re-election next year.
But that plan has run into problems. The health insurance industry is revving up its lobbying against sweeping reforms; Republicans decry as "socialist" a proposed government-run health plan; the public is wary of the cost. And the Democrats are divided over how to pay for it all.
While Obama has set the overall goals of expanding insurance coverage to most Americans and holding down skyrocketing medical costs, he has left the tough details to lawmakers in the Democratic-controlled House and Senate.
The result is that Democrats have been squabbling among themselves while Republicans have sat back grinning.
Obama has called Senate Democrats to a White House meeting on Tuesday where healthcare is expected to be a major topic.
Four congressional committees, one in the Senate and three in the House of Representatives, have approved sweeping healthcare overhaul legislation without a single Republican supporting the bills. But fiscally conservative Democrats had to be brought on board with ideas that may lose liberal votes.
Taking a different approach, Senate Finance Committee leaders have been trying to hammer out a bipartisan package, but Democratic leaders want them to wind up by September 15.
"I think the timeline is more than fair," Schumer said. "If we cannot produce a bipartisan solution by then, you have to wonder if the Republicans would ever be willing to agree to anything."
He said Democrats were prepared to consider some "contingencies" for pushing a bill through Congress if Finance Committee negotiators — three Democrats and three Republicans, fail to produce a bipartisan bill.
"These plans will likely be considered only as a last resort, but make no mistake about it, they remain on the table," Schumer said. "Health reform is just too important to let this window pass by."
In one encouraging sign, Senator Charles Grassley, the chief Republican healthcare negotiator, told Radio Iowa he thought the timing could be right for passage by the end of November — if they reach a deal in early September.
If no bipartisan plan can be brought up in the Senate, among the contingencies Democrats could turn to is a budget procedure known as "reconciliation." That would give the healthcare bill privileged status and allow it to pass with a simple 50 vote majority rather than the 60 votes usually needed to advance legislation in the 100-member Senate.
Democrats control 60 votes in the Senate, but may need some Republican support to overcome procedural hurdles. Senators Edward Kennedy and Robert Byrd are seriously ill and have missed most votes this year.
The healthcare overhaul is one of the most complex legislative attempts by Congress. It carries a pricetag of $1 trillion over 10 years, is more than 1,000 pages long, and will place new obligations on every American and all businesses operating in the United States.
It would set up a government-run insurance plan to compete with private insurers, an idea branded by Republicans as a government takeover of the medical and insurance industry. The Senate Finance Committee is looking at a compromise that would set up nonprofit cooperatives to compete with private insurers.
The bills would require Americans to buy health insurance, help those who cannot afford it, and oblige most large and many small employers to contribute to the cost for their workers.
The insurance industry would see reforms that would bar them from charging more or refusing to cover people because of their medical histories. And doctors and hospitals would see their Medicare payments based on quality of care not the number of services they order.