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House Democrats clear health hurdle

Medicare pact reached, but obstacles loom

By David Espo
Associated Press / July 25, 2009

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WASHINGTON - House Democrats announced agreement yesterday on far-reaching steps designed to rein in the relentless growth of Medicare, part of a concerted effort to counter the impression that President Obama’s healthcare legislation is in deep trouble.

Speaker Nancy Pelosi hailed the agreement as a “giant step forward’’ for the bill that Obama has made a test of his leadership.

Advocates said it eventually would turn Medicare toward a program that rewards quality, rather than volume, as well as alter a system that pays doctors and other providers more in some regions of the country than others.

Yet the leadership all but abandoned a pledge to approve legislation before lawmakers are scheduled to begin a monthlong vacation next Friday.

“We have every intention of passing it by the fall,’’ said Representative Steny Hoyer of Maryland, the majority leader.

Separately, talks between the leadership and rebellious conservative and moderate Democrats demanding changes in the bill remained deadlocked, so much so that they briefly collapsed during the day before being revived.

The maneuvering in Congress came as Obama met at the White House with Senate majority leader Harry Reid, Democrat of Nevada, and Senator Max Baucus, Democrat of Montana, the chairman of the Finance Committee, who has been trying for months to produce a bipartisan agreement.

“I said to [Obama] what I say to everybody. We are ready when we are ready,’’ Baucus said later.

Obama has worked energetically in public appearances, interviews, meetings with lawmakers, and a prime-time news conference this week to advance legislation he wants to expand coverage to millions without insurance at the same time it restraints the growth of healthcare generally.

“I’m fully committed to making that happen,’’ Obama said in an interview yesterday on healthcare.

Despite his efforts, Republicans have grown more emboldened as efforts in Congress stall, and some have suggested that defeat of the drive to remake healthcare could cripple his presidency, now in its sixth month.

Reid announced on Thursday that he was abandoning his timetable of passing legislation in the Senate before lawmakers begin their vacation, saying Republicans involved in the bipartisan negotiations had asked for more time.

Reid said he expects Baucus to produce a bill within the next two weeks, though, and that the Finance Committee will vote on it in early August.

Across the Capitol, Pelosi virtually ordered a small group of Democrats from rural and urban areas to thrash out differences Thursday night on Medicare issues that sound arcane, but matter enormously to individual lawmakers and will probably also lead to cuts in spending growth.

“This is just one piece of the puzzle, but we think it’s an important piece,’’ said Representative Xavier Becerra, a Californian.

Lawmakers said the agreement would lead to changes in Medicare to try to reward doctors, hospitals and other providers for high-quality care. Critics argue the current system simply pays by volume - compensating providers regardless of whether additional medical procedures contribute to better healthcare.

Under the agreement, the Institute of Medicine would complete a study by September 2011 recommending changes in the current structure for determining reimbursement.