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Obama urges Congress to stay vigilant on healthcare

Proposes steps to reduce costs 2 House panels OK parts of bill

President Obama made his way to an appearance yesterday in which he told Congress that “now is not the time to slow down.’’ President Obama made his way to an appearance yesterday in which he told Congress that “now is not the time to slow down.’’ (Alex Brandon/Associated Press)
By David Espo
Associated Press / July 18, 2009
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WASHINGTON - President Obama sought to reassure jittery Democrats yesterday that healthcare legislation was within reach, although he urged his party to take bolder steps to address long-term cost concerns.

Democratic defections on two House committees yesterday underscored divisions among the party’s rank-and-file over the scope of the bill, along with its massive price tag. The latest rebellion stirred among newly elected Democrats who are wary of the surtax on wealthy households that the House bill would impose - a cudgel for Republicans, who portray the tax as a killer for small businesses.

Despite the warning signs, Obama asserted from the White House, “We are going to get this done. We will reform healthcare. It will happen this year. I’m absolutely convinced of that.’’

With every new brush fire, Obama faces growing pressure to relent on his midsummer deadline for House and Senate passage. That marker was established to keep momentum going, but with two weeks remaining on the House calendar and three in the Senate before lawmakers recess, the timetable appears all but unattainable.

Yet so far, the president has refused to yield. “I realize that the last few miles of any race are the hardest to run, but I have to say now is not the time to slow down, and now is certainly not the time to lose heart,’’ Obama said. “We’re going to be putting in a lot more hours, there are going to be a lot more sleepless nights, but eventually this is going to happen.’’

Obama, who also plans a primetime news conference Wednesday and a healthcare event in Cleveland Thursday, did not mention the August recess.

Instead, he urged lawmakers and the public to look past the daily ups and downs and focus on the “unprecedented progress’’ toward overhauling healthcare: hospitals and drug companies have pledged givebacks to help pay for the bill, the American Medical Association and American Nurses Association endorsed legislation this week, and broad agreement on major elements of the bill.

The Senate Finance Committee appeared yesterday to be making slow, but steady progress on its legislation, the one version of healthcare changes expected to gain bipartisan support. At a meeting late Thursday, negotiators identified about a dozen remaining areas of disagreement, including a revenue gap of about $100 billion. Senate sources said committee aides would work through the weekend on outstanding questions, with the goal of producing a draft bill by Tuesday.

Douglas Elmendorf, director of the Congressional Budget Office, sent shock waves through the Capitol Thursday when he declared that proposals already on the table from the House and the Senate Health Committee would fail to achieve “the sort of fundamental changes’’ necessary to rein in the skyrocketing cost of government health programs, particularly Medicare.

Along with closing the uninsured gap, restraining cost growth is a primary goal of the reform effort. But Democrats have yet to agree to controversial measures needed to “bend the cost curve.’’

Obama announced yesterday that he would back one such step, a proposal requiring Congress to surrender authority over Medicare changes and reimbursement rates to an independent group of medical experts. Lawmakers cherish their power to adjust payments to local doctors, hospitals, and other providers, and as a rule, they ignore warnings from the Medicare Payment Advisory Commission, established by Congress in 1997, to adopt drastic changes to save the program from collapse.

“What we want to do is force the Congress to make sure that they are acting on these recommendations to bend the cost curve each and every year, so that we’re constantly adjusting and making changes,’’ Obama said yesterday.

House Speaker Nancy Pelosi acknowledged concerns about the proposal, but said they could be overcome “under certain circumstances.’’

Senate negotiators, meanwhile, are pressing Obama to retreat from his campaign opposition to a health-insurance benefits tax that Elmendorf and other analysts regard as a vital cost-containment tool. Senate tax aides are examining ways to close the tax loophole so it does not harm middle-class workers.

One possible compromise would be to tax insurance companies, rather than beneficiaries, on large policies, an idea floated years ago by Bill Bradley, the former New Jersey senator. Senate aides who have studied the proposal said it could achieve the same aim of discouraging overuse of healthcare, but without the direct hit to beneficiaries that Obama is determined to avoid. Some Senate Democrats said they are increasingly hopeful that the White House will sign off on the idea - especially if Congress embraces the independent commission.

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