Health care bill could hit House, Senate floors mid-month

Historic health care legislation could be on the floor of both houses of Congress as early as mid-October as Democrats work to answer President Barack Obama’s call for greater protections for those who have unreliable insurance or no coverage at all.

Senate Majority Leader Harry Reid, D-Nev., said Wednesday the Senate debate could begin the week of Columbus Day, Oct. 12, even though lawmakers are scheduled to be on vacation at the time.

Democratic aides said the House was working on roughly the same timetable, although after months of missed deadlines, neither House Speaker Nancy Pelosi nor Reid would provide a detailed schedule.

Debate in the Senate could take weeks, compared with mere days in the House.

But even now, two weeks before the projected start of debate, key decisions are yet to be made about elements of the bills.

Reid must decide, for example, whether to include an option for the government to sell insurance in competition with private industry, a provision sought by liberals who argue it would subject private insurers to much-needed competition.

Legislation that cleared the Senate Health, Education, Labor and Pensions Committee earlier in the year includes the so-called public option, but the Senate Finance Committee twice rejected proposals along those lines this week.

There is no such uncertainty in the House, where Pelosi has said it will be included in legislation that goes to the floor.

And even at this late date, Democrats in both houses are struggling to find ways to hold down the cost of the overhaul legislation while assuring quality health coverage for millions of lower-income individuals and families.

In the House, the issue has been the subject of closed-door negotiations in recent days, as Democratic leaders try to reduce the cost of their bill to the $900 billion over 10 years set by Obama.

In the Senate, Finance Committee Democrats worked privately on the same issue.

One proposal under consideration, according to senators and aides, was advanced by Sen. Maria Cantwell, D-Wash., and was modeled on a system in her home state that advocates say has achieved significant cost savings.

Federal subsidies ticketed for lower-income uninsured would flow to the states. The states, in turn, would negotiate with private insurers to provide coverage for the target population. Aides said the proposal would be designed to provide coverage for about three-quarters of the nation’s uninsured.

Democrats have a 13-10 majority on the committee.

On Wednesday, as Obama lobbied reluctant Democrats by phone to support the Finance Committee measure, the bill’s architect expressed confidence it would have enough votes to clear the committee as early as week’s end.

“We’re coming to closure,” said Sen. Max Baucus, D-Mont., the committee chairman.

Baucus said, “It’s clear to me we’re going to get it passed,” although he sidestepped a question about possible Republican support.

Olympia Snowe of Maine is the only GOP senator whose vote is in doubt, and she has yet to tip her hand. While she has voted with Democrats on some key tests — to allow the government to dictate the types of coverage that must be included in insurance policies, for example — she has also sided with fellow Republicans on other contentious issues.

Republicans tried repeatedly Wednesday to force changes in the bill relating to taxes, abortion and illegal immigrants, but were turned back nearly every time on votes that fell largely along party lines.

By contrast, Sen. Bill Nelson, D-Fla., was successful in winning a change to shield seniors from the impact of a tax increase in the bill for individuals and families seeking to exclude certain medical expenses from their income. Under current law, taxpayers who itemize their deductions are permitted to escape taxes on health costs that exceed 7.5 percent of their adjusted gross income.

Baucus’ legislation would raise the threshold to 10 percent, but on a vote of 14-9, Nelson succeeded in returning it to 7.5 percent for taxpayers age 65 and over.

Moments later, Sen. Jon Kyl of Arizona sought to give younger taxpayers the same break, but his proposal failed, also on a vote of 14-9.

One bipartisan amendment also cleared.

Backed by Sen. John Ensign, R-Nev., and Tom Carper, D-Del., it would allow discounts and reductions in insurance premiums for individuals who enroll in voluntary wellness programs designed to reduce their health care costs.