WASHINGTON — Even as Speaker Nancy Pelosi affirmed her commitment to pass far-reaching health care legislation this year, members of Congress and health policy experts began Thursday to deal with the reality that a smaller bill would have a better chance. þþPassage of a comprehensive bill looked impossible after the Democrats’ loss of a Senate seat in Massachusetts. As an alternative, lawmakers in both parties said, some pieces of the bills already passed by the House and the Senate could be pulled out and packaged together in a measure that would command broad support.þþThe consensus measure would be less ambitious than the bills approved last year. It would extend insurance coverage to perhaps 12 million to 15 million people — and provide political cover to Democrats, who said they could not simply drop the issue after spending so much time and effort on it.þþThe pared-back approach would cover fewer than half of those who, according to the Congressional Budget Office, would gain coverage under the House and Senate bills. But it would not put the government on the hook for what critics say is a new entitlement, a change that would appeal to some Republicans.þþWhile no decisions have been made and the White House was reluctant to concede it would not get a bigger bill, Congressional aides were working to identify common ground.þþMs. Pelosi said House Democrats remained committed to passing health legislation, but would not simply accept the Senate version of the bill and send it to President Obama.þþ“In its present form without any change, I don’t think it’s possible to pass the Senate bill in the House,” Ms. Pelosi said. “I don’t see the votes for it at this time.”þþRepresentative Gerald E. Connolly, Democrat of Virginia, said the 2,000-page House bill might have been “too much, too ambitious for an anxious public.”þþBut Mr. Connolly said, “Doing nothing is not a good option.”þþLawmakers, Congressional aides and health policy experts said the package might plausibly include these elements:þþ¶Insurers could not deny coverage to children under the age of 19 on account of pre-existing medical conditions.þþ¶Insurers would have to offer policyholders an opportunity to continue coverage for children through age 25 or 26.þþ¶The federal government would offer financial incentives to states to expand Medicaid to cover childless adults and parents.þþ¶The federal government would offer grants to states to establish regulated markets known as insurance exchanges, where consumers and small businesses could buy coverage.þþ¶The federal government would offer tax credits to small businesses to help them defray the cost of providing health benefits to workers.þþ¶If a health plan provided care through a network of doctors and hospitals, it could not charge patients more for going outside the network in an emergency. Co-payments for emergency care would have to be the same, regardless of whether a hospital was in the insurer’s network of preferred providers.þþThe package could also include changes in Medicare, to reduce the growth in payments to doctors and hospitals while rewarding providers of high-quality, lower-cost care. To help older Americans, it could narrow a gap in Medicare coverage of prescription drugs, sometimes known as a doughnut hole.þþSara Rosenbaum, a professor of health law and policy at George Washington University, said the proposals were “totally doable” and could help perhaps 15 million people.þþ“Medicaid already covers poor children through age 18 and could be expanded to cover all nonelderly poor people, regardless of age,” Ms. Rosenbaum said. This proposal does not go as far as the House or Senate bill, but she said, “It’s an idea that has been supported in the past by health policy experts across the political spectrum.”þþDemocrats on Thursday were still trying to absorb the implications of their defeat in the special Senate election in Massachusetts, where an upstart Republican won the seat long held by Senator Edward M. Kennedy.þþThe White House said Mr. Obama wanted to let “the dust settle” before rushing forward on a health care bill. þþLikewise, Ms. Pelosi said, “we’re not in a big rush.” þþIt is, she said, prudent to pause and “reflect upon what our possibilities are.”þþSome politicians have suggested that Massachusetts voters were expressing a desire for Democrats to work more closely with Republicans. But Ms. Pelosi said that would be difficult because Republicans had made “it clear that they are not for health care reform, and we are.”þþAt a closed-door meeting of the House Democratic Caucus on Thursday, some lawmakers, like Representative Gene Taylor of Mississippi, compared the Republican victory in Massachusetts to Hurricane Katrina. They said the election results had blown away any chance of passing a huge bill, just as the hurricane had swept away houses.þþOther Democrats, like Representative Jerrold Nadler of New York, denounced an agreement to finance coverage of the uninsured by imposing a tax on high-cost health plans. The agreement was announced last week by White House officials and labor union leaders. þþ“People were scathing in their criticism of the excise tax,” Mr. Nadler said, even though collectively bargained health plans would be exempt until 2018. þþRepresentative Anthony Weiner, Democrat of New York, said: “We should take a step back and say, ‘What are the things people really want out of health care, the things that are popular?’ Then we could step back in and try again.”þþSenator Olympia J. Snowe, Republican of Maine, said Thursday that compromise was possible, but that Mr. Obama and Democratic Congressional leaders needed to start over. þþ“We just really have to peel back the layers of the onion here, so to speak, and go back to the drawing board, and try to see what essentially could be a basis for consensus,” Ms. Snowe said. þþAreas of potential agreement, she said, include aid to small businesses and regulation of the insurance industry to prohibit “the most egregious practices.” þþMs. Snowe supported an earlier version of the bill approved by the Senate Finance Committee, but then turned against the legislation after Senate Democrats made major changes without consulting Republicans.þþThe House Republican leader, Representative John A. Boehner of Ohio, said Ms. Pelosi and Mr. Obama were ignoring the message of the Massachusetts election. “They are still scheming and scrambling to find a way to pass their government takeover of health care,” Mr. Boehner said. And he warned, “If they jam it through, I think they are going to face a firestorm from the American public.”þ
Source: NY Times
