Dems increasingly confident of passing health plan

McClatchy Newspapers

WASHINGTON — Despite the strains of sky-high costs and public skepticism, the government is moving steadily toward a vast health-care overhaul that would at least partly fulfill a six-decade quest for universal coverage and could rein in soaring costs for everyone else.

The White House is ramping up its behind-the-scenes lobbying of Congress. President Barack Obama is signaling that he could drop some key principles of his campaign if necessary to jump-start negotiations, opening the door to broad tax increases and a plan that could, he now concedes, push people into a government-run insurance program against their will. Senate Democrats also said last week that they were heading toward agreement again after a momentary stall.

“We have a lot of hard slogging to go, but ... I think that we are in good shape,” White House Chief of Staff Rahm Emanuel said Thursday.

Republicans, too, concede that the Democrats who control Congress and the White House are back on track to push an overhaul into law.

“They’re going to be pushing their version of reform through. And they probably will get it done by the end of the year,” said Rep. Paul Ryan, R-Wis. “Unfortunately, it doesn’t look like it’s going to be a bipartisan health-care reform, or the kind that we’ve been proposing, because Democrats, quite literally, they have the votes.”

The votes? Probably. The details? Not quite yet.

Two big questions still loom: How will the government pay for insurance for the 50 million people now uninsured, and will the government offer its own insurance to compete with 1,300 private insurance companies in hopes of driving down costs?

Obama thinks he’s found a way to pay for almost all of a price tag estimated at $1 trillion over 10 years: by cutting Medicare and Medicaid and by raising taxes on those making more than $250,000 a year through limits on their itemized tax deductions.

But many congressional Democrats prefer to raise taxes on health insurance itself, which is now deducted from taxable income.

Some propose capping the deduction at $13,000 to $17,000 a year, so that the most expensive plans would be taxed and even discouraged.

Obama, who opposed taxing health coverage when Republican John McCain proposed it during their campaign, now says he’s open to some version of it.

“I continue to believe that’s not the best way to do it,” Obama said at a White House town hall meeting last week. “But I think there are people in good faith who are saying a cap would at least prevent these ‘Cadillac’ plans that end up having people over-utilizing the system. ... I’m pushing my idea. Other folks are pushing their ideas. There’s going to have to be some compromise at the end of the day.”

Some of his allies don’t like that.

“Six months after he’s sworn in to office, to say, ‘I changed my mind on this,’ is wrong,” independent Vermont Sen. Bernard Sanders said. “It’s a regressive way to raise revenues.”

Congressional Democrats also are debating whether to include a so-called “public option,” which would be a government program akin to Medicare available to everyone.

Supporters say it would create competition and drive down costs; critics say the government plan, with no profit margin and perhaps taxpayer subsidies, would drive private insurers out of business.

Obama conceded last week that the availability of lower-cost government insurance could violate one of his keystone promises: not to force people to give up doctors or insurance plans they like. He acknowledged that companies providing health insurance might choose the less-expensive government insurance over their private insurers, thus forcing employees into the government fold.

“When I say ... you have a doctor and you like your doctor, that you don’t have to change plans, what I’m saying is the government is not going to make you change plans,” Obama said at a White House news conference.

Obama clearly wants the government insurance option.

“The president has made it pretty clear he ... feels very strongly that having a public option to compete with private insurers is the best way to cost containment,” Health and Human Services Secretary Kathleen Sebelius said Friday.

That feeds complaints from opponents that the Democratic plan would lead eventually to most Americans’ getting insurance from the government.