Health care vote a race to the wire

The House of Representatives on Saturday night passed an amendment to pending health care legislation that prohibits federal funds for abortion services in the public option and in the insurance “exchange” the bill would create.

The vote passed 240-194.

The amendment was introduced by anti-abortion Democrats. Its consideration was considered a big win for them and for the U.S. Conference of Catholic Bishops, which used its power — especially with conservative Democrats in swing congressional districts — to help force other Democratic leaders to permit a vote that most of them oppose.

The prohibition, introduced by Democratic members, including Rep. Brad Ellsworth, D-Indiana, and Rep. Bart Stupak, D-Michigan, would exclude cases of rape, incest or if the mother’s life is in danger.

Republicans strongly supported the measure.

The GOP accounted for 174 of the votes in favor of the amendment, with 1 Republican voting “present.”

On the Democrat’s side, 64 voted for the measure, and 194 voted against.

The vote came just before the House was set to vote on the full health reform bill, and indications were that the vote could come down to the wire.

House Democrats needed 218 votes to pass the health care bill. Without any Republican support, that meant Democrats can lose no more than 40 of their own members. And as the House appeared to near a vote late Saturday night, CNN confirmed at least 35 Democrats planned to vote no. Another dozen or so had not made public commitments or were undecided.

In other words, if no Republicans voted yes, Democrats could afford to lose only five more members of their 258-member caucus on the issue.

As late as 8:30 p.m. ET, some key Democrats were still undecided.

According to their offices, Reps. Bob Etheridge, D-North Carolina, and Daniel Lipinski, D-Illinois, were still wrestling with a vote that was expected within hours.

Nonetheless, House Speaker Nancy Pelosi and other Democratic leaders repeatedly insisted they will have the 218 votes necessary to pass their health care bill when it comes up for a vote. In a sign that could indicate confidence, Pelosi’s office called a news conference following the health care vote listing the time at about 11 p.m. ET.

Earlier Saturday, President Obama said members of the House of Representatives face the chance of a lifetime as they consider the legislation.

After a meeting with the House Democratic leadership, the president said he told lawmakers that “opportunities like this come around maybe once in a generation.”

“This is their moment, this is our moment, to live up to the trust that the American people have placed in us,” Obama told reporters in the White House rose garden. “Even when it’s hard, especially when it’s hard, this is our moment to deliver.”

He had just returned from Capitol Hill, where the House had begun debate on the nearly $1.1 trillion health care bill.

A senior Democratic aide quoted the president as saying during the meeting that he was “absolutely confident” that they would pass the legislation.

“When I sign this in the rose garden, each and every one of you will be able to look back and say, ‘This was my finest moment in politics,’” the aide quoted Obama as saying. Anti-abortion Democrats will introduce an amendment to the measure that would ban most abortion coverage from the public option and other insurance providers in the new so-called “exchange” the legislation would create, three Democratic sources told CNN.

The prohibition would exclude cases of rape, incest or if the woman’s life is in danger.

House Minority Leader John Boehner said the GOP leadership strongly supports that amendment.

“We believe taxpayer funding of abortion is wrong, and we will do everything we can to stop that from happening, by passing the Stupak amendment,” he said.

The fact that the amendment will be allowed to be proposed is a big win for anti-abortion Democrats and the U.S. Conference of Catholic Bishops, which used its power — especially with conservative Democrats in swing congressional districts — to help force Democratic leaders to permit a vote that most of them oppose.

“We didn’t have a choice,” said a Democratic leadership source. “We didn’t have the votes” on health care without agreeing to this compromise.

Planned Parenthood decried the amendment, saying it would result in the elimination of abortion coverage currently offered by most private health insurance plans.

“This amendment would violate the spirit of health care reform, which is meant to guarantee quality, affordable health care coverage for all by creating a two-tiered system that would punish women, particularly those with low and modest incomes,” the group said in a statement.

The Democratic sources said people would be able to use their own money to purchase insurance policy riders that include abortion coverage.

“I foresee for poor women in America a return to the dark ages,” said Rep. Alcee Hastings, D-Florida.

Meanwhile, members of the Congressional Hispanic Caucus staunchly oppose including a provision that would bar undocumented workers from using their own money to buy health insurance policies available through the exchange.

Learn about the bill

The measure is already included in the Senate Finance Committee’s version of the bill and is backed by the White House. Some conservative House Democrats have also indicated their support for the Senate language.

Several Hispanic Caucus members who discussed the issue with Pelosi on Friday said they had received assurances the Senate language would not be included. Rep. Charlie Gonzalez, D-Texas, warned Thursday that several caucus members might try to block the House bill if it’s changed to conform to the Senate measure.

Pelosi’s bill includes various requirements for immigrants to verify their citizenship before getting federal subsidies to buy health insurance. Conservatives, however, have called the requirements insufficient.

Many conservatives and Blue Dog Democrats also continue to raise questions about the overall cost of the bill.

“The speaker’s bill includes job-killing taxes and mandates that will hurt small businesses,” Boehner said Friday. “For the sake of our families and small businesses, this job-killing bill needs to be defeated.”

The House bill would extend insurance coverage to 36 million uncovered Americans and guarantee that 96 percent of Americans have coverage, according to the nonpartisan Congressional Budget Office.

Among other things, the bill would subsidize insurance for poorer Americans, establish a new government-run public option and create health insurance exchanges to make it easier for small groups and individuals to purchase coverage. It would also cap annual out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Pelosi’s office has said the bill would cut the federal deficit by roughly $30 billion over the next decade. The measure is financed through a combination of a tax surcharge on wealthy Americans and spending constraints in Medicare and Medicaid.

Palin stands by ‘death panel’ claim on health bill

Former Alaska Gov. Sarah Palin refused to retreat from her debunked claim that a proposed health care overhaul would create “death panels,” as the growing furor over end-of-life consultations forced a key group of senators to abandon the idea in their bill.

Sen. Chuck Grassley, R-Iowa, one of six lawmakers negotiating on a Senate bill, said Thursday they had dropped end-of-life provisions from consideration “entirely because of the way they could be misinterpreted and implemented incorrectly.”

In a Facebook posting titled “Concerning Death Panels,” Palin argued Wednesday night that the elderly and ailing would be coerced into accepting minimal end-of-life care to reduce health care costs based on the Democratic bill in the House.

But there will be no “death panels” under the legislation being considered. In fact, the provision in the bill would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health care proxy, learning about hospice as an option for the terminally ill, and information about pain medications for people suffering chronic discomfort.

The sessions would be covered every five years, more frequently if someone is gravely ill.

The American Medical Association and the National Hospice and Palliative Care Organization support the provision.

In her posting, Palin wrote: “With all due respect, it’s misleading for the president to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients.” She added, “It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing.”

The issue is no longer viable for the six members of the Senate Finance Committee — three Republicans and three Democrats — working on a bipartisan bill, according to Grassley. In a statement, he criticized the House bill, saying there was a difference between a “simple education campaign, as some advocates want,” and paying “physicians to advise patients about end-of-life care.”

The provisions remain in the House bill.

Palin’s posting came one day after Republican Sen. Lisa Murkowski of Alaska said that Palin and other critics were not helping the GOP by tossing out false claims. Portions of the Democratic health care bills “are bad enough that we don’t need to be making things up,” Murkowski said, invoking a phrase that Palin used in her resignation speech, when she asked the news media to “quit making things up.”

Murkowski said she was offended at the “death panel” terminology. “There is no reason to gin up fear in the American public by saying things that are not included in the bill,” she said.

Palin hasn’t always been against end-of-life counseling. As Alaska governor, she signed a proclamation making April 16, 2008, Healthcare Decision Day with the goal to have health care professionals and others participate in a statewide effort to provide clear and consistent information about advance directives.

The proclamation noted that only about 20 percent of Alaskans, and 50 percent of severely or terminally ill patients, have an advance directive. “It is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about advance directives,” it said.

Georgia Sen. Johnny Isakson, a Republican who co-sponsored a similar measure in the Senate, said it was “nuts” to claim the bill encourages euthanasia.

And Rep. Earl Blumenauer, D-Ore., who authored the provision on end-of-life counseling, said he is astounded that Palin has not tempered her bleak descriptions of the health care bill.

“It’s deliberate at this point,” Blumenauer said. “If she wasn’t deliberately lying at the beginning, she is deliberately allowing a terrible falsehood to be spread with her name.”

He said the measure would block funds for counseling that presents suicide or assisted suicide as an option, calling references to death panels or euthanasia “mind-numbing.”

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Poll: Americans divided on health care overhaul

As supporters and opponents of overhauling the health care system try to shape public opinion at congressional town-hall-style meetings, both sides face a big complication: Public opinion on the issue is complex in ways that defy an easy Republican-Democratic divide.

Analysis of a recent USA TODAY/Gallup Poll finds views on what priority to emphasize, how fast to act and what’s important to protect vary and sometimes conflict depending on a person’s age and region of the country, whether he or she has insurance, and is healthy or ailing.

Seniors are by far the most resistant to the idea of changing the current system — an opening for opponents who have focused on proposed cuts in Medicare spending and accusations about planning for “end-of-life” care. The idea of controlling insurance costs has broader support overall than expanding coverage for the uninsured, which has prompted the White House to begin describing its goal as “insurance reform.”

Meanwhile, in an op-ed article in today’s USA TODAY, House Speaker Nancy Pelosi and House Majority Leader Steny Hoyer, both Democrats, decry what they call “un-American” tactics used to disrupt some congressional forums.

Senate Republican Leader Mitch McConnell on Fox News Sunday accused Democrats of trying “to demonize citizens who are energetic about this.”

An analysis of results from a USA TODAY survey July 10-12 illustrates some of the crosscurrents in public opinion. The poll of 3,026 adults has a margin of error of +/—2 percentage points. The poll found:

•Significant differences on what the key goal of a health care overhaul should be. Two-thirds of blacks and six in 10 Hispanics say it should be expanding coverage to the uninsured, but six in 10 whites say controlling costs. Westerners are inclined to say expanding coverage is more important; Southerners say it’s controlling costs.

•Challenges in convincing most Americans that it is urgent to act this year, as Obama argues. There’s less urgency among those who have insurance and whose health is excellent or good — groups that make up the majority of those polled.

•Resistance among seniors. Fewer than half of seniors polled want an overhaul enacted this year.

Obama: Health overhaul key to economic recovery

Using better-than-expected jobs numbers to press his top domestic priority, President Barack Obama is arguing that overhauling the health care system is essential to the country’s economic well-being.

Republicans countered that the high unemployment rate — 9.4 percent in July — shows how families and businesses are struggling and that Obama’s reliance on a large government role in expanding health coverage is the wrong approach.

A net total of 247,000 jobs were lost last month, the fewest in a year and a drastic improvement from the 443,000 that vanished in June as the U.S. tries to pull out from the worst recession since World War II.

“We’ve begun to put the brakes on this recession and … the worst may be behind us,” Obama said in his weekly radio and Internet address Saturday. He cited Friday’s Labor Department report that showed a dip in unemployment, but said, “We must do more than rescue our economy from this immediate crisis. We must rebuild it stronger than before.”

He added: “We must lay a new foundation for future growth and prosperity, and a key pillar of a new foundation is health insurance reform.”

It’s a pitch that comes as the Democratic-controlled Congress struggles to write a health care plan that meets Obama’s goals of expanding coverage to millions of uninsured while reining in exploding costs.

“So far they have produced a measure that they cannot sell even to their own members,” Senate GOP leader Mitch McConnell said in a jab at majority Democrats. “The only thing bipartisan, so far, is the opposition.”

With lawmakers embarking on a monthlong summer break, opponents and supporters of various proposals under consideration are waging fierce campaigns. Obama is redoubling his effort to explain his positions to a public that polls say is becoming increasingly wary he can deliver on his promise to revamp health care.

The president argued that Congress was close to finalizing “real health insurance reform” but, as he has for weeks now, he warned against listening to opponents who he said were spewing misleading information and outlandish claims to defeat “the best chance of reform we have ever had.”

Obama was getting a boost from Secretary of State Hillary Rodham Clinton, who as first lady led the failed effort in the 1990s to overhaul health care.

In an interview with CNN set to air Sunday, Clinton called Congress’ latest work on the issue “a very healthy process,” though she acknowledge serious differences in viewpoints that must be bridged.

Even so, she said: “I actually agree that at the end of the day, with all of this negotiation and back and forth, you know, we’re going to come up with something” and “my hope is that it’s going to be meaningful enough to make a difference … on the cost side.”

Countering the Democratic position, Bob McDonnell, the Republican nominee for Virginia governor, argued that the new Labor Department report was “yet another reminder that families and small businesses are struggling as unemployment remains high.”

In the GOP’s response address, McDonnell sought to draw distinctions between Republicans and Democrats on economic and health care policy.

“As Republicans, we believe you create jobs by keeping taxes and regulation low, and litigation at a minimum. Americans succeed when government puts in place positive policies that encourage more freedom, and more opportunity,” he said.

McDonnell also said that, unlike Democrats, Republicans are committed to helping the uninsured — “not through nationalizing the system with a costly government-run plan, but rather by supporting free-market incentives and helping small-business owners make coverage more accessible and affordable, and ensuring that Americans can keep their individual private policies.”

Abortion measure passes, then fails, in House

An anti-abortion amendment to a sweeping health overhaul bill was voted down in a House committee late Thursday — a dramatic reversal just hours after the measure initially was approved.

The amendment said health care legislation moving through Congress may not impose requirements for coverage of abortion, except in limited cases. It was approved in the Energy and Commerce Committee after conservative Democrats joined Republicans to support it.

But committee Chairman Henry Waxman, D-Calif., invoked House rules that allowed him to bring up the amendment for a second vote, despite Republican objections.

This time, one conservative Democrat — Rep. Bart Gordon of Tennessee — changed his vote from “yes” to “no.” And a second conservative Democrat who hadn’t voted the first time — Rep. Zack Space of Ohio — voted “no.”

It was enough to take down the amendment on a 30-29 vote.

Obama: Health care reform means changes in treatment for the better

President Obama said Wednesday he was unable to guarantee that health care reform won’t change how Americans get medical treatment, but he said any changes would be necessary and positive.

President Obama is urging Congress to move quickly to pass comprehensive health care reform.

In a nationally televised news conference dominated by the health care issue, Obama delivered lengthy statements in response to Republican attacks on proposals he favors.

He also attempted to ease the concerns of people left confused by the fierce debate in Washington.

He repeatedly emphasized that the spiraling costs of the current system would bankrupt the nation while denying coverage to millions more Americans.

Asked directly if he could guarantee that an overhauled health care system won’t change how people receive treatment, Obama said no.

“The whole point of this is to try to encourage what works,” Obama said, addressing concerns that reform would take away the ability of people to choose their doctors and treatment.

He noted that some insurance companies recently reported record profits, and said offering a competing government-funded health plan would require private insurers to offer less-expensive coverage.

Speaking about the benefits of his plan, he said it would offer “security” and “stability” to sick and healthy Americans.

“It will prevent insurance companies from dropping your coverage if you get too sick. It will give you the security of knowing that if you lose your job, move, or change your job, you will still be able to have coverage. It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money,” he said.

He also said his program would not add to the deficit over the next decade, addressing concerns from Republican opponents and fiscally conservative Democrats over the costs of the program.

“Already, we have estimated that two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs. This includes over $100 billion in unwarranted subsidies that go to insurance companies as part of Medicare — subsidies that do nothing to improve care for our seniors,” he said.

Obama also chided opponents of his health care reform push for making the issue purely political.

“I’ve heard that one Republican strategist told his party that even though they may want to compromise, it’s better politics to ‘go for the kill.’ Another Republican senator said that defeating health reform is about ‘breaking’ me,” he said.

“Let me be clear: This isn’t about me,” Obama said, noting that he and every member of Congress — including those trying to scuttle health care reform legislation — “have great health insurance.”

Instead, he said, the debate is about people lacking health insurance because they can’t afford rising costs, get denied due to a pre-existing condition, or lose their jobs.

“This debate is not a game for these Americans, and they cannot afford to wait for reform any longer,” Obama said.

He also confirmed an agreement with fiscally conservative Democrats to create an independent group of doctors and medical experts empowered to eliminate waste and inefficiency in Medicare.

Obama said he backed adding such a panel to health care reform legislation.

Such a panel could both save money and “ensure the long-term financial health of Medicare,” Obama said.

So-called “Blue Dog” Democrats questioning the costs of initial health care bills said Obama gave a “verbal agreement” Tuesday to including the independent panel in health care reform legislation.

Earlier Wednesday, Obama worked the phones, urging lawmakers to embrace health care reform, White House Communications Director Anita Dunn said Wednesday.

It follows the president’s Tuesday meeting with Democrats at the White House, dubbed a “serious working session” where “major progress” was made, Dunn said.

Officials said Obama will be taking a more hands-on approach with members of Congress in the days and weeks to come regarding the health care debate.

White House aides say the administration is concerned about three centers of serious opposition from House Democrats: the fiscally conservative Blue Dog Democrats who are worried about the cost of a public health care plan; the freshmen and other Democrats from high-income districts who are concerned about taxes for high-income Democrats, and the anti-abortion Democrats who are concerned about federal funding going for abortion services, and whether health care providers can opt out of certain procedures.

One official said the administration is aware that “if any of these three groups abandon the effort the bill would be impossible to get out of committee, much less pass.”

Aides say the president and lawmakers also discussed the public option versus a co-op option.

“The government is already making some of these decisions,” Obama said. “Insurance companies are making some of these decisions.”

The reform proposals he backs would have experts make decisions based on the best medical treatment, not accountants attempting to save money or doctors prescribing treatments that bring the highest fees, Obama said.

“This will require patients … to be more discriminating consumers,” he said. “I think that’s a good thing. Ultimately … we just can’t afford what’s happening right now.”

Republican opponents of Democratic bills in the House and Senate said earlier that most Americans like the current system, which they said must be made less expensive and more accessible.

Obama and Democratic leaders say the problems are deeper and systemic, and the president spent all of his seven-minute opening statement at the 52-minute news conference outlining the challenges and his proposed solutions.

“Even as we rescue this economy from a full-blown crisis, we must rebuild it stronger than before — and health insurance reform is central to that effort,” Obama said.

“If we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket,” he said.

As he laid out the list of benefits that health care reform offers, he dropped a direct reference to a government-funded public health insurance option.

Until now, Obama has consistently touted the government-funded public option as competition for private insurers in expanding access to health coverage.

It was unclear if Obama changed the wording to avoid a label opposed by Republican supporters, or if he was signaling a policy shift toward a compromise being negotiated by the Senate Finance Committee to have health insurance cooperatives rather than a government-funded public option.

Republican Sen. Charles Grassley of Iowa told CNN on Wednesday that the Finance Committee was not considering a public option.

Later in the news conference, Obama responded to a question about the public option by saying it was intended to “keep the insurance companies honest.

Obama pushes House on health care initiative

With his signature health care initiative buffeted from all sides, President Barack Obama is summoning key House Democrats to the White House as he increases pressure on Congress to get the job done.

Democrats on the House Energy and Commerce Committee — the only one of three House panels weighing health overhaul legislation that has yet to pass it — were to meet with the president Tuesday afternoon, the White House announced.

That follows a committee drafting session that lasted past midnight Monday as panel members slogged through numerous amendments, with majority Democrats turning back Republican attempts to change the bill. But Committee Chairman Henry Waxman’s bigger difficulties were with his own party, particularly a bloc of fiscally conservative Democrats who oppose the legislation in its current form over costs and other issues.

Waxman and his aides have been deep in talks with these conservative “Blue Dog” Democrats, and as the panel wrapped up its work in the wee hours Waxman announced he was canceling a drafting session planned for Tuesday so negotiations could continue.

“We’re having conversations with different members to work out some of the issues so we can make this thing move forward,” Waxman, D-Calif., told reporters. He declined to elaborate.

Rep. Mike Ross, D-Ark., who chairs the Blue Dog health care task force, said earlier in the evening that there was still plenty of work to be done. “If you’re wondering if we’ve reached some agreement, the answer is no,” said Ross.

It remained to be seen whether the president’s involvement would change that.

The House bill would, for the first time, require all individuals to have health insurance and all employers to provide it. The poor would get subsidies to buy insurance and insurers would be barred from denying coverage based on pre-existing conditions.

Prior to his meeting with the Energy and Commerce Democrats on Tuesday, Obama planned brief remarks on health care, something that’s become a near-daily occurrence as the president has moved swiftly from hands-off to deeply engaged on his top domestic priority.

Obama’s increased personal involvement comes with Republican criticism sharpening, outside groups growing more strident and sticker shock reverberating around Capitol Hill in the wake of a bleak prognosis from the Congressional Budget Office last week saying lawmakers’ health proposals wouldn’t hold down costs.

Obama has repeatedly cited lowering costs as a top goal of any health overhaul plan, alongside extending coverage to the 50 million uninsured.

Meanwhile the president’s own poll numbers are slipping. And while he’s continuing to say he wants health care legislation to pass this year, he’s grown less insistent about the House and Senate passing bills before leaving Washington for their August recess.

“I want this done now. Now, if there are no deadlines, nothing gets done in this town,” Obama told PBS’s “The NewsHour” on Monday. “If somebody comes to me and says, ‘It’s basically done, it’s going to spill over by a few days or a week,’ you know, that’s different.”

Obama planned a prime-time news conference Wednesday and a town hall in Ohio on Thursday.

On Capitol Hill, the legislation moved forward fitfully after concrete advances last week, when three committees — one in the Senate and two in the House — passed sweeping health overhaul bills. But the bills attracted no GOP support, and in each House committee several Democrats defected and opposed the legislation.

The toughest lift was in Energy and Commerce but there were indications Monday some concerns were being soothed. Rep. Bart Stupak, D-Mich., who with other anti-abortion Democrats had threatened to oppose the bill over concerns it would fund abortions, said a compromise was being worked out that would protect state laws on abortion. Stupak didn’t give details and aides said there was no final deal.

Meanwhile, House Speaker Nancy Pelosi is floating an idea that could make proposed tax increases more palatable to the Blue Dogs. She would like to limit income tax increases to couples making more than $1 million a year and individuals making more than $500,000, Pelosi spokesman Brendan Daly said Monday. The bill passed by the House Ways and Means Committee last week would increase taxes on couples making as little as $350,000 a year and individuals annually making as little as $280,000.

In the Senate, negotiators seeking a bipartisan compromise reported progress Monday. Finance Committee Chairman Max Baucus, D-Mont., said there’s tentative agreement on four big policy issues out of a list of about one dozen. He would not elaborate.

Obama, GOP trade barbs in health care fight

The battle to overhaul health care intensified Monday, with President Obama accusing GOP critics of putting politics ahead of policy and a top Republican saying Democrats’ plans would undermine the country’s economic future.

President Obama visits the Children’s National Medical Center in Washington on Monday.

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Meanwhile, Max Baucus, D-Montana, the chairman of the Senate Finance Committee, said Monday that closed-door talks involving Democratic and Republican members resulted in a tentative agreement on several substantive issues as part of what is considered the first possible bipartisan health care bill.

Also Monday, an aide to House Speaker Nancy Pelosi said she was willing to limit a proposed tax increase in a House health care bill after some Democrats threatened a revolt on the issue.

Monday's developments came as Democrats struggled to regain much-needed political momentum on the high-priority issue before the August congressional recess.

Obama and other Democratic leaders are seeking an overhaul to ensure that health insurance is available to 46 million uninsured Americans while preventing costs to the government and individuals from climbing.

In a visit to the Children's National Medical Center in Washington, the president seized on recent remarks by Sen. Jim DeMint, R-South Carolina. In reference to the health care debate, DeMint said, "If we're able to stop Obama on this, it will be his Waterloo. It will break him."

Obama said, "Think about that. This isn't about me. This isn't about politics."

He said, "This is about a health care system that is breaking America's families, breaking America's businesses and breaking America's economy. And we can't afford the politics of delay and defeat when it comes to health care. Not this time, not now."

Obama's critique came a few hours after Republican National Committee Chairman Michael Steele blasted the president for pushing "a risky multitrillion-dollar experiment with our health care."

The plan "not only risks our economy, it risks every American's health, too," Steele said during an appearance at the National Press Club.

"Under [the Democratic] plan, costs are going up, and you, the American people, are going to pay.”

Steele also criticized congressional Democrats for attempting to pass a health care bill without reaching out to the GOP minority or “permitting any meaningful scrutiny.”

Top administration officials, while defending their efforts with congressional Republicans, have conceded that more work is needed to ensure that whatever bill eventually gets passed is budget neutral.

To pay for reform, the House Democrats’ current health care bill would impose a 5.4 percent surtax on individuals making $280,000 or more and families making $350,000 or more.

Pelosi, however, is now suggesting the surtax start with individuals making $500,000 and families making $1 million, according to a Pelosi aide. Pelosi first raised the idea in an interview with Politico.

“The speaker has said several times she would like to squeeze more savings out of the system, and if we can do that, we can reduce the number of people affected by the surcharge,” said Brendan Daly, a spokesman for Pelosi.

Last week, 22 freshmen House Democrats sent a letter to Pelosi saying they were “extremely concerned” about what the taxes in the bill might do to small businesses.

House Republican Conference Chairman Mike Pence, R-Indiana, slammed the surtax in any form.

“It almost boggles the mind that the majority in Congress would continue headlong down a pathway toward increasing the tax burden on anyone at a time when our economy is shedding hundreds of thousands of jobs per month,” Pence said.

Appearing Sunday on NBC’s “Meet the Press,” Health and Human Services Secretary Kathleen Sebelius said an additional tax on wealthy Americans is “a legitimate way to go forward” in the debate over how to overhaul the ailing health system.

A final bill “will be paid for — it will not add to the deficit,” Sebelius said.

The House and Senate are working on Democratic proposals that would create a government-funded public health insurance option intended to drive down costs of private coverage.

However, the nonpartisan Congressional Budget Office reported last week that the measures under consideration in both chambers would fail to pay for themselves, increasing the budget deficit.

Republican opponents were quick to seize on the CBO report as ammunition against Obama’s push to have a bill from each chamber approved by the time Congress begins recess on August 7.

Democrats argued the CBO analysis failed to take into account the financial impact of cost-cutting measures under discussion as well as how stronger preventive care programs will reduce demand and costs.

The White House has so far resisted another idea for raising revenue — creating a tax on the medical benefits provided by employers. Baucus said he likes the idea, but Obama said it could be too disruptive to a system in which 180 million Americans have health coverage provided by their employers.

“Essentially employers would stop providing health care,” the president said Monday in an interview with the PBS program “Newshour.”

Baucus said he would meet again with Finance Committee leaders on Tuesday to try to work out a compromise palatable to both parties. He refused to provide details of issues agreed to already, only describing them as “major significant issues that have been in the health care reform public domain.”

The skirmishing over health care comes as a new national poll indicates Obama’s ratings are slipping on the issue.

Forty-nine percent of people questioned in an ABC News/Washington Post survey released Monday approve of the way Obama is handling health care. That approval is down 4 percentage points from June and 9 points from April. Forty-four percent disapprove, up 5 percentage points from June and 15 points from April.

The ABC News/Washington Post poll is the third national survey to suggest the president’s approval rating on overhauling health care is under 50 percent, joining a CBS News poll and a Quinnipiac University survey.At the same time, the new poll also indicates Obama still has a large advantage over Republicans on the issue. Fifty-four percent of those questioned say they trust Obama to do a better job handling health care than Republicans in Congress, with 34 percent putting more faith in the latter than the president.

Official: 5 plans revamp health care, none final

President Barack Obama’s advisers are urging critics of their health care overhaul to wait for Congress to finish writing legislation before issuing verdicts. They also signaled they are willing to wait longer than their White House-imposed August deadline for action if it means they can sway wary lawmakers.

The White House spent Sunday defending Obama’s health care proposals and stressing that Congress has not yet written the final draft of legislation that would dramatically reshape how Americans receive health care. Instead, they said, Republicans — and even some Democrats — should wait until a final bill takes form.

“There are basically five different plans in Congress right now and there are a variety of ways,” Health and Human Services Secretary Kathleen Sebelius said, trying to calm nervous lawmakers whose re-elections could hinge on the legislation.

“More will be done,” she said. “The House and the Senate are committed to working with the president to get this done.”

Getting it done by August, though, appeared to be pushed back. Administration officials said they still have a goal for the Senate and the House to pass separate bills before an August recess, leaving reconciliation of their differences for September or later. But they slid away from a once-firm do-it-this-summer demand.

“We think we can make that. We’re working towards that,” White House budget director Peter Orszag said. “And we have to remember, there are some who are advocating the delay simply because they don’t have anything to put on the table. … There are those who are advocating delay just as a desperation move to try to kill this.”

The United States is the only developed nation that does not have a comprehensive national health care plan for all its citizens, and Obama campaigned on a promise to offer affordable health care to all Americans. However, the recession and a deepening budget deficit have made it difficult to win support for costly new programs.

“The House has one approach. We put forward a different approach. The Senate is considering yet more options,” Orszag said. “The key thing is we need to get there in a way that is deficit neutral.”

Paying for the health care plan remains the major challenge, underscored by a nonpartisan Congressional Budget Office report that emerging House legislation would increase deficits by $239 billion over a decade.

“I don’t follow why we’ve got to spend another $1.5 trillion to $2 trillion, most people estimate, on top of the $2.5 trillion we’re already spending in this country and yet still have, under one estimate, at least 33 million people without health insurance,” said Sen. Orrin Hatch, R-Utah. “I mean, these are things that are real serious problems.”

Democrats insisted the budget analysis ignores savings and Obama’s pledge not to add red ink to the federal ledger.

“It’s clear that they’re working with different assumptions than the White House and the Congress is,” said Rep. Charlie Rangel, D-N.Y., the chairman of the House tax-writing committee.

Even so, the politics of adding to the deficit or raising taxes is tricky. Obama officials have refused to rule out a tax on the wealthiest Americans and oppose a tax on employer-provided health care benefits.

Overhauling health care won’t come cheap.

Republicans paint Obama’s proposals as a massive tax that would leave small businesses wounded, employers shifting away from private plans toward a government-based system and workers without coverage. Obama’s advisers have argued that revamping health care is vital to the nation’s long-term economic recovery.

Michael Steele, the chairman of the Republican party, is accusing Obama of conducting “risky experimentation” with his health care proposals, saying they will hurt the economy and force millions to drop their current coverage.

In remarks prepared for delivery at the National Press Club, Steele also said the president, Speaker Nancy Pelosi and key committee chairman are part of a “cabal” that wants to implement government-run health care.

Obama has repeatedly said he does not favor a government-run health care system. Legislation taking shape in the House envisions private insurance companies selling coverage in competition with the government.

Officials: Health care proposal a work in progress

Administration officials defended President Barack Obama’s broad health care proposals on Sunday and urged a skeptical public not to judge the Democrats’ overhaul until Congress writes a final version.

Facing independent budget predictions that contradict the White House’s rhetoric, officials sought to refute Republican objections to massive changes in how Americans receive health care. They emphasized that Congress has not yet settled on an outline for health care legislation and reiterated Obama’s desire for a bipartisan approach.

“This is a work in progress,” Health and Human Services Secretary Kathleen Sebelius said, trying to calm nervous lawmakers whose re-elections could hinge on the legislation. “More will be done. The House and the Senate are committed to working with the president to get this done.”

The United States is the only developed nation that does not have a comprehensive national health care plan for all its citizens, and Obama campaigned on a promise to offer affordable health care to all Americans. However, the recession and a deepening budget deficit have made it difficult to win support for costly new programs.

“The House has one approach. We put forward a different approach. The Senate is considering yet more options,” White House budget director Peter Orszag said. “The key thing is we need to get there in a way that is deficit neutral.”

Paying for the health care plan remains the major challenge, underscored by a nonpartisan Congressional Budget Office report that emerging House legislation would increase deficits by $239 billion over a decade.

“I don’t follow why we’ve got to spend another $1.5 trillion to $2 trillion, most people estimate, on top of the $2.5 trillion we’re already spending in this country and yet still have, under one estimate, at least 33 million people without health insurance,” said Sen. Orrin Hatch, R-Utah. “I mean, these are things that are real serious problems.”

Democrats insisted the budget analysis ignores savings and Obama’s pledge not to add red ink to the federal ledger.

“It’s clear that they’re working with different assumptions than the White House and the Congress is,” said Rep. Charlie Rangel, D-N.Y., the chairman of the House tax-writing committee.

Even so, the politics of adding to the deficit or raising taxes is tricky. Obama officials have refused to rule out a tax on the wealthiest Americans and oppose a tax on employer-provided health care benefits. They also want the Senate and the House to pass separate bills before an August recess, leaving reconciliation of their differences for September or later. White House officials grudgingly accept that such a timetable — which has shifted from being a demand to more of a goal — might force them into policy compromises.

“What we have said is this bill has to be deficit neutral,” said Orszag, a former top budget chief for Congress. “We think there are better ways of obtaining additional revenue, and we have to let this legislative process play out.”

But it won’t come cheap. That means increased taxes and political opposition.

Republicans paint Obama’s proposals as a massive tax that would leave small businesses wounded, employers shifting away from private plans toward a government-based system, and workers without coverage. Some GOP members have also cautioned that the legislation could fund abortions, a fear crucial to the social conservatives who hold sway inside the Republican Party and a proposition Orszag would not rule out.

A key Republican, however, warned his party not to scuttle health care legislation over abortion.

“No matter what your views are on abortion, you shouldn’t ask people to use their tax dollars if they think that abortion is taking a life,” said Sen. Judd Gregg, R-N.H. “I would hate to see the health care debate go down over that issue. … Hopefully we won’t get ourselves wrapped around the wheel of abortion in this debate.”

Obama’s advisers have argued that overhauling health care is vital to the nation’s long-term economic recovery.

About 50 million of America’s 300 million people are without health insurance. The government provides coverage for the poor and elderly, but most Americans rely on private insurance, usually received through their employers. However, not all employers provide insurance and not everyone can afford to buy it. With unemployment rising, many Americans are losing their health insurance when they lose their jobs.

The insurance industry, which fought President Bill Clinton’s health care effort in 1993 and 1994, is beginning to run its first TV ads of this year’s health care fight. The multimillion-dollar campaign, being aired nationally on cable stations, restates the industry’s support for an overhaul that provides universal coverage and its offer to cover people who are already sick. The ad campaign, which starts Monday, does not mention the insurers’ strong opposition to creating a government-run insurance option.

Seeking to prod colleagues, Sen. Edward M. Kennedy wrote an essay for Newsweek magazine about the policy that has guided his decades in the Senate.

“Unless we act now, within a few years, 55 million Americans could be left without coverage even as the economy recovers,” wrote the Massachusetts Democrat, who is being treated for brain cancer. “All Americans should be required to have insurance. For those who can’t afford the premiums, we can provide subsidies.”