By Alex Wayne and Edward Epstein CQ Staff
While the goal of health care overhaul is a given among House Democrats the size shape and extent of the plan hinges on the demands of a handful of pivotal members.
Work on the bill is at a standstill as moderate Democrats on the House Energy and Commerce Committee push for the bill to be recast to provide greater cost savings fewer mandates on small businesses and a weakened government-run insurance plan lawmakers say.
On Tuesday members of the fiscally conservative Blue Dog Coalition sent the committees chairman
Henry A. Waxman D-Calif. a list of 10 changes they want to the bill. Mike Ross D-Ark. who chairs the coalitions health care task force said top issues include greater cost containment a more generous exemption for small businesses from requirements that they provide insurance and changes to the government-run plan that Democrats want to create to compete with private insurers.
In a three-hour meeting at the White House Tuesday afternoon Ross said the Blue Dogs reached a verbal agreement" with Waxman and President Obama to work on language for the bill (HR 3200) that would create an independent board with the power to influence payment rates for Medicare and possibly other programs.
We consider that a significant breakthrough" Ross said.
Waxman said late Tuesday that talks among Democrats on health care legislation may have reached a turning point" as negotiations zero in on creating the cost-containment board. He said he still has reservations about the powers of the proposed board but added that the ongoing talks present us with an opportunity to fashion it see that it has real teeth."
We have other issues yet to talk through" Waxman said. But I see this opportunity to hold down the curve in health care costs as a major turning point."
Waxmans committee already started considering amendments to the bill a process known as a markup but put Wednesdays planned session on hold.
As Obama tries to steer a health care overhaul through Congress the Blue Dogs are the most closely watched group of lawmakers in the House. They have warned for months that they might not be able to support the developing legislation chiefly because of the so-called public plan" an idea opposed by insurers business groups and nearly all Republicans.
Last week the Blue Dogs were further emboldened after the Congressional Budget Office (CBO) director Douglas W. Elmendorf said that the House bill would not significantly reduce health costs and his agency warned about deficit spending.
The CBO last week was really a hit across the bow"" Baron P. Hill D-Ind. a Blue Dog member of Energy and Commerce said Tuesday.
An aide to a senior Energy and Commerce Democrat said that the Blue Dogs had made a non-negotiable" demand" that the bill be amended enough that Elmendorf could issue a letter confirming the legislation would bend the cost curve" for health care spending.
But the chairmen of congressional committees with jurisdiction over Medicare Waxman Ways and Means Chairman Charles B. Rangel D-N.Y. and Senate Finance Chairman Max Baucus D-Mont. all oppose the idea as do many other lawmakers. They worry that voters might hold them accountable if the independent board were to impose spending cuts that result in reduced services.
The Blue Dogs arent the only Democrats Waxman has to worry about.
Bart Stupak D-Mich. who is not a Blue Dog but often sides with them said he respectfully declined" the White House invitation.
Stupak ticked off his own list of concerns with the bill: He wants health plans to be paid based on value or outcomes not utilization";"he wants a provision added that would require hospitals and doctors to publicly disclose prices for their services; and he wants a vote on a conscience clause" that would allow health providers to decline to provide services they find objectionable such as abortion.
He also wants at least a vote on an amendment that would prevent the government from requiring insurers to cover abortion.
I will not vote for this bill unless I have the opportunity to express my opinion on it" Stupak said.
House Speaker Nancy Pelosi D-Calif. told Democrats Tuesday that she was still working to assemble enough support to proceed with a floor vote. The point she made was that we are on track and that she is intent on next week""said Pelosis spokesman Nadeam Elshami.
On the Senate side Majority Leader Harry Reid D-Nev. said that bipartisan talks in the Senate Finance Committee were progressing and that a formal markup of a bill Baucus is developing could begin as early as Saturday.
My desire is to get it done this work period" Reid said and Im going to continue pushing . . . to do everything I can to get it done this work period. But the goal is not deadlines the goal is comprehensive health care reform."
The Finance Committee met Tuesday with the Joint Committee on Taxation discussing ways to pay for some of the estimated $1 trillion cost of their bill Baucus said. Options include a tax on health insurance premiums and taxing some employer-sponsored health benefits.
Drew Armstrong and Kathleen Hunter contributed to this story.
