WASHINGTON — Before President Barack Obama can sign health care legislation, his biggest sales challenge will be convincing his fellow Democrats in Congress to enact his plan.
The party is badly, even bitterly, divided over a host of hard-to-resolve issues — including the scale of government involvement, cost and abortion — making it impossible to predict whether Obama can muster the 218 House of Representatives and 60 Senate votes he needs to enact a bill.
Party leaders say that the turmoil is typical.
"We will have a bill," House Speaker Nancy Pelosi, D-Calif., said flatly in an interview with McClatchy.
Crafting a health care compromise, she said, isn't even the most difficult task she's had recently.
"The hardest thing I've had to do all year is (get more funding for) Iraq and Afghanistan," Pelosi said, recalling last spring's fight to provide more money for the two wars. "People just did not want to do it."
While almost all Democratic lawmakers want to overhaul America's health care system, however, there's no consensus on how to do it. With almost all Republicans opposed to any plan the Democratic majority favors, the measure must draw near-united Democratic support in order to pass.
Fifty-two of the 256 House Democrats consider themselves "Blue Dogs," or conservatives. They're concerned about any plan's cost and wary of being tagged as expanding Washington's reach by creating a government-run "public option" alternative to private health insurance. If the Blue Dogs stick together, Pelosi would need the support of more than a dozen Republicans to forge a 218-vote House majority, which seems all but impossible.
In addition, 18 House Democrats want tougher anti-abortion language in the legislation, which many Democrats who favor abortion rights oppose.
Pelosi, among many, also favors higher income tax rates on the rich, which most Senate Democrats reject.
The Senate faces a different numbers game. Sixty votes are needed to overcome procedural hurdles, and Democrats now control 59 seats. Within a few weeks, Massachusetts Gov. Deval Patrick is expected to name an interim replacement for the late Sen. Edward Kennedy; former Gov. Michael Dukakis and former Democratic National Committee Chairman Paul Kirk are mentioned most prominently.
Because Senate Democrats are split by the same disagreements as House Democrats, however, securing support from all 60 is going to be tough, even though at least two Republicans, Maine's Olympia Snowe and Susan Collins, have signaled a willingness to compromise, though not on a public option.
After Oct. 15, the Senate could pass a health care plan with 51 votes because of a rules change, but Democrats are reluctant to use that weapon, fearing a huge backlash.
Obama has tried mightily of late to promote party unity, starting with his address Sept. 9 to a joint session of Congress and continuing with more public rallies this week and private meetings with members of Congress.
When they were asked whether the White House push has helped forge consensus, Democrats were guarded in response.
"The president has improved the atmosphere," said Sen. Evan Bayh, D-Ind.
The focus next week will be on the Senate Finance Committee, whose 13 Democrats and 10 Republicans will begin writing legislation Tuesday. They hope to finish within two weeks.
When Chairman Max Baucus, D-Mont., unveiled his starting-point package Wednesday, he found little Democratic support. He proposed no public option but included a blueprint for creating co-ops, or nonprofit groups run by consumers that would use their collective clout to bargain for lower health-insurance prices.
The biggest hint of the volatility to come was evident in the comments of the committee's second-ranking Democrat, West Virginia's Jay Rockefeller. After Baucus released the plan, Rockefeller said, "There is no evidence that co-ops would bring costs down or make insurance more affordable. ... We can do better."
Then he met with Obama, and he was somewhat more conciliatory Thursday, saying, "You can't get everything you want."
The Finance Committee bill eventually will be combined with legislation from the Senate Health, Education, Labor and Pensions Committee, which includes a public option. The full Senate probably will consider the merged version next month.
Three House committees have written versions. Those will be combined into a single bill. That version had been expected to be taken up next week, but many House Democrats want to wait for the Senate, so the timing is unclear.
What is clear is that Democrats have several difficult issues to resolve. Among them:
_ Cost. The nonpartisan Congressional Budget Office gave Baucus' bill an important boost, finding that it would cost $774 billion over 10 years — less than Baucus estimated — and would reduce the federal deficit by $49 billion.
That's an important point for fiscal conservatives, many of whom were dismayed when the CBO found that the House legislation would boost deficits by $239 billion over the next 10 years.
"The Baucus bill looks like a lot more fiscally prudent than the Energy and Commerce (Committee) bill, and that's a good thing," said Rep. Artur Davis, D-Ala.
_ Public option. Liberals, who control roughly 80 House seats, insist on this.
"Many of us on the liberal side have already moved a great deal on this issue,' said Rep. Anthony Weiner, D-N.Y. Many wanted a "single payer" system, similar to Medicare for all.
However, most Blue Dogs want nothing to do with a public option. "I believe a costly government-run public option is the wrong direction for reform, and I will not support it," said Rep. Mike Ross, D-Ark., a leading Blue Dog.
_ Taxes. There are two problems here: Vulnerable freshman Democrats who are trying to defend their seats against Republicans who aren't shy about using the "higher tax" issue against them, and Democrats of every stripe who dislike Baucus' insurance tax idea.
House Democratic leaders prefer an income-tax surcharge on singles with adjusted gross incomes of more than $280,000 annually and couples who make more than $350,000. Baucus prefers a 35 percent excise tax on insurance companies' policies that cost more than $8,000 for singles and $21,000 for families.
Pelosi and a lot of Senate Democrats see that as a middle-class tax increase. "I don't see that as taxing Cadillac plans; I see that as taxing lower-cost cars," she said.
The CBO estimates that the tax would raise $214.9 billion, making it an important part of the Baucus plan.
_ Abortion. Anti-abortion Democrats want explicit language barring federal funding for abortion except in cases of rape, incest or in which the woman's life is endangered. Many were upset when the House Energy and Commerce Committee included a provision in its bill that would permit certain abortion services to be provided, though federal funding would be strictly limited.
"I am not willing to compromise my values and beliefs over this issue," said Rep. Bart Stupak, D-Mich. "If Democrats do not allow a vote to restrict abortion, he said, "we will try to shut down" the process, preventing the bill from going to the floor.
Pelosi said she was undeterred by all the hurdles. House Democrats have been holding lengthy closed-door meetings this month to iron out differences. The meetings centered this week on issues involving seniors. Sessions next week are expected to deal with small business and the public option.
Still, when lawmakers and activists are asked where the compromise may come, there are few answers.
"Everyone agrees on the what. Congress still needs to agree on the how," said Clifton Gaus, the president of Health Reform USA, an advocacy group in Holmes Beach, Fla.
Pelosi remained adamant that a public option will be in legislation that passes the House. When she was asked whether it will be in the final bill that clears the House and Senate, however, she said only, "I would certainly hope so."
ON THE WEB
Congressional Budget Office analysis of House bills
Congressional Budget Office analysis of Baucus bill
Side-by-side comparison of health care bills
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