Top House Democrats on Tuesday left open the prospect of President Obama's comprehensive health care overhaul failing and passing pieces of it, a process already being used to try to repeal health insurance industry antitrust protections.
The antitrust measure, which was not in the reform framework Mr. Obama released Monday, could pass the House Wednesday with bipartisan support, which would mark the first time Republicans and Democrats have been able to agree in the health debate. It would come a day ahead of Mr. Obama's health summit.
House Majority Leader Steny H. Hoyer said Democrats support Mr. Obama's outline, but if a complete overhaul bill can't get through Congress, there are good pieces that should become law.
"We may not be able to do it all," he said. "I hope we can do it all in a comprehensive piece of legislation that would provide affordable, accessible, quality health care to all Americans. But having said that, if we can't, then you know me - if you can't do a whole, doing part is also good."
House Speaker Nancy Pelosi stressed the importance of repealing the antitrust protections and that Democrats can simultaneously pass a small bill alongside work on the comprehensive bill.
"We will be taking up comprehensive health insurance reform shortly but we wanted to make sure that in paving the way for that legislation we paved the way for fairness, for competition, for better care, better quality, better affordability for the American people," she said.
The antitrust bill repeals the 1945 McCarran-Ferguson Act that exempted the insurance industry from federal antitrust rules.
"For too may decades the health insurance companies have enjoyed monopoly protections that are enjoyed really by no other industry, with the exception of Major League Baseball," said Rep. Tom Perriello, the Virginia Democrat who introduced the bill. "The result of this has been a lack of competition and a lack of accountability that has helped send prices up for consumers and working families across the country."
It's unclear what impact the repeal would have. Democrats say it would increase competition and stop bid rigging and price fixing. Insurance companies oppose it because they say it would lead to regulatory confusion and that state law already prevents anticompetitive practices.
The Congressional Budget Office, Congress' nonpartisan budgetkeeper, found that the repeal would have "no significant effects" on the federal budget or private insurance premiums.
Insurers say McCarran-Ferguson never allowed them to engage in price-fixing or bid-rigging.
"Health insurance is one of the most regulated industries in America at both the federal and state levels," said Karen Ignagni, president and chief executive officer of America's Health Insurance Plans (AHIP), an industry trade group. "The Act is extremely limited in scope and has nothing to do with competition within the health insurance industry."
AHIP says that insurers are subject to federal antitrust laws in addition to other state and federal regulations.
The repeal has support in the Senate as well. Nineteen Democrats signed on to a letter to Mr. Obama, Ms. Pelosi and Mr. Reid asking them to include the repeal in their final health bill.
White House spokesman Robert Gibbs said Tuesday that the antitrust bill would be done in addition to a comprehensive bill, not instead of.
"This will ultimately complement health care reform in ensuring the changes that you make in the market - that the ability to look into potential anti-competitive practices, that that's not, quite frankly, illegal to do," he said. "This is not in lieu of something to make broader changes in the insurance market. This is a complementary step along the way."
Democrats on Capitol Hill say they are cautiously supportive of Mr. Obama's health reform outline, which closely follows what the Senate passed in December but includes a number of repairs designed to please the House.
The plan was written with reconciliation in mind, White House officials said. That's the complicated procedural tool Democrats could use to pass the bill with only 51 votes, circumventing a Republican filibuster.
Senate Majority Leader Harry Reid said Democrats have not decided to pursue that route but chastised Republicans, who on Tuesday labeled the proposed use of reconciliation a rare procedural "trick."
"I've been told that my Republican friends are lamenting reconciliation, but I would recommend for them to go back and look at history," Mr. Reid said. "Since 1981, reconciliation has been used 21 times. The vast majority of those reconciliation efforts have been by Republicans ... realistically, they should stop crying about reconciliation as if it's never been done before."
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