Even with a Democrat in the White House and Democrats running Congress creating a major health law is proving to be a slow go.
The bill that was supposed to be released by Friday isnt ready and one of the key Republicans involved in negotiations suggests it might be time to start over and try to accomplish less.
Early Thursday it seemed that House Democrats were making significant progress toward finishing their bill.
They had agreed to include a surtax on wealthy Americans starting at $250000 in income in the measure to pay for some of its cost. The rate for the surtax would have been graduated with people earning $500000 or more paying a higher rate according to Rep. Pete Stark D-Calif.
But the surtax provision and other proposals in the House bill led a group of fiscal conservatives to take some simmering concerns about the overhaul public. In a letter to Speaker Nancy Pelosi D-Calif. 40 members of Blue Dog Coalition wrote that they had strong reservations" about the bill and cannot support a final product" unless it addresses those concerns.
One of the Democrats in the Blue Dog group Mike Ross of Arkansas said he had approached privately White House Chief of Staff Rahm Emanuel Health and Human Services Secretary Kathleen Sebelius and House Majority Leader Steny Hoyer D-Md. to express the caucus concerns.
Unsatisfied they took their complaints public.
Pelosi called members of the caucus into a meeting that stretched more than two hours late Thursday. More meetings were planned for Friday.
Stark said some of the Blue Dogs concerns were frustrating to Democratic leaders. Its difficult to cut Medicare and increase Medicare which is what they want" he said.
Earlier Thursday Pelosi urged chairmen of the three committees working on the legislation to hold down the cost of their bill. I have told the Three Tenors we must wring every possible dollar out of the health system ... in order to help cut the cost" Pelosi said.
Pelosi said she told them Squeeze out what you can from the system savings savings savings. ... Otherwise the bill is endless."
The Blue Dogs in their letter seemed to be in line with Pelosis goal. They said the bill must start with finding savings within the current delivery system and maximizing the value of our health care dollar before we pay more."
That 51-member caucus could carry some weight in the health care overhaul debate especially if members decide to vote against a bill.
Blue Dogs are also demanded changes to the bill regarding how the health care system pays doctors hospitals and other providers with the goal of rearranging incentives to lower costs. Stark said he had proposed a new method of negotiating payments with hospitals that he hoped might satisfy some of their concerns.
In the Senate lawmakers led by Finance Committee Chairman Max Baucus D-Mont. are trying to get costs down as well and trying to rely as much as possible on reduced costs squeezed out of the health care system instead of any tax increase.
Finance Committee members had been looking at a variety of revenue raisers principal among them taxing employer-provided health benefits which would have yielded up to $320 billion over a decade.
Under pressure from other Democrats the committee appears to have dropped that idea leaving them to scramble for money to fill the gap.
The full Finance Committee went over revenue and financing options Thursday morning a meeting that created some tensions as GOP lawmakers left grumbling.
Any time you introduce taxes into the funding mechanism it raises the probability of opposition" said Olympia J. Snowe R-Maine another of the lawmakers working with Baucus.
Orrin G. Hatch of Utah was one Republican who was upset by the high cost of the package and the ways that were being considered to pay for it.
After the full committee meeting Thursday morning Hatch voiced his frustration with the high cost of health care overhaul and the plans that Democrats were making to pay for it. I really am coming to the conclusion that we ought to take care of the 13 to 16 million people that really are left out" Hatch said referring specifically to people who make less than $75000 but do not qualify for government programs like Medicaid and the Childrens Health Insurance Program.
There were roughly 46 million uninsured in the United States in 2008. Hatch said he was growing tired of the high cost of the more expansive ideas Democrats were proposing to cover them.
I think we oughta... get out of this trillions of dollars realm that were in right now and start doing some practical things right now that might work" said Hatch.
Its still going to be expensive but its not going to be trillions of dollars like theyre talking about" he added referring to the idea of scaling back a coverage expansion.
Republicans who have been negotiating with Baucus predicted that they would still make the August deadline to complete Senate work.
We still have a few weeks we still have a month to go" said Hatch who is also a member of the Health Education Labor and Pensions (HELP) Committee which continues to work on its own health bill.
Joseph J. Schatz and Edward Epstein contributed to this report.
Even with a Democrat in the White House and Democrats running Congress creating a major health law is proving to be a slow go.
The bill that was supposed to be released by Friday isnt ready and one of the key Republicans involved in negotiations suggests it might be time to start over and try to accomplish less.
Early Thursday it seemed that House Democrats were making significant progress toward finishing their bill.
They had agreed to include a surtax on wealthy Americans starting at $250000 in income in the measure to pay for some of its cost. The rate for the surtax would have been graduated with people earning $500000 or more paying a higher rate according to Rep. Pete Stark D-Calif.
But the surtax provision and other proposals in the House bill led a group of fiscal conservatives to take some simmering concerns about the overhaul public. In a letter to Speaker Nancy Pelosi D-Calif. 40 members of Blue Dog Coalition wrote that they had strong reservations" about the bill and cannot support a final product" unless it addresses those concerns.
One of the Democrats in the Blue Dog group Mike Ross of Arkansas said he had approached privately White House Chief of Staff Rahm Emanuel Health and Human Services Secretary Kathleen Sebelius and House Majority Leader Steny Hoyer D-Md. to express the caucus concerns.
Unsatisfied they took their complaints public.
Pelosi called members of the caucus into a meeting that stretched more than two hours late Thursday. More meetings were planned for Friday.
Stark said some of the Blue Dogs concerns were frustrating to Democratic leaders. Its difficult to cut Medicare and increase Medicare which is what they want" he said.
Earlier Thursday Pelosi urged chairmen of the three committees working on the legislation to hold down the cost of their bill. I have told the Three Tenors we must wring every possible dollar out of the health system ... in order to help cut the cost" Pelosi said.
Pelosi said she told them Squeeze out what you can from the system savings savings savings. ... Otherwise the bill is endless."
The Blue Dogs in their letter seemed to be in line with Pelosis goal. They said the bill must start with finding savings within the current delivery system and maximizing the value of our health care dollar before we pay more."
That 51-member caucus could carry some weight in the health care overhaul debate especially if members decide to vote against a bill.
Blue Dogs are also demanded changes to the bill regarding how the health care system pays doctors hospitals and other providers with the goal of rearranging incentives to lower costs. Stark said he had proposed a new method of negotiating payments with hospitals that he hoped might satisfy some of their concerns.
In the Senate lawmakers led by Finance Committee Chairman Max Baucus D-Mont. are trying to get costs down as well and trying to rely as much as possible on reduced costs squeezed out of the health care system instead of any tax increase.
Finance Committee members had been looking at a variety of revenue raisers principal among them taxing employer-provided health benefits which would have yielded up to $320 billion over a decade.
Under pressure from other Democrats the committee appears to have dropped that idea leaving them to scramble for money to fill the gap.
The full Finance Committee went over revenue and financing options Thursday morning a meeting that created some tensions as GOP lawmakers left grumbling.
Any time you introduce taxes into the funding mechanism it raises the probability of opposition" said Olympia J. Snowe R-Maine another of the lawmakers working with Baucus.
Orrin G. Hatch of Utah was one Republican who was upset by the high cost of the package and the ways that were being considered to pay for it.
After the full committee meeting Thursday morning Hatch voiced his frustration with the high cost of health care overhaul and the plans that Democrats were making to pay for it. I really am coming to the conclusion that we ought to take care of the 13 to 16 million people that really are left out" Hatch said referring specifically to people who make less than $75000 but do not qualify for government programs like Medicaid and the Childrens Health Insurance Program.
There were roughly 46 million uninsured in the United States in 2008. Hatch said he was growing tired of the high cost of the more expansive ideas Democrats were proposing to cover them.
I think we oughta... get out of this trillions of dollars realm that were in right now and start doing some practical things right now that might work" said Hatch.
Its still going to be expensive but its not going to be trillions of dollars like theyre talking about" he added referring to the idea of scaling back a coverage expansion.
Republicans who have been negotiating with Baucus predicted that they would still make the August deadline to complete Senate work.
We still have a few weeks we still have a month to go" said Hatch who is also a member of the Health Education Labor and Pensions (HELP) Committee which continues to work on its own health bill.
Joseph J. Schatz and Edward Epstein contributed to this report.
