The White House signaled that an aggressive, all-Democratic strategy for overhauling the nation's healthcare system remains a serious option, even as President Barack Obama invites Republicans to next week's televised summit to seek possible compromises.
Obama plans to have a healthcare proposal that "will take some of the best ideas and put them into a framework" ahead of the Feb. 25 summit, said Health and Human Services Secretary Kathleen Sebelius. The White House has invited Republicans to bring their own proposals, but GOP leaders have treated the event warily at best.
Meanwhile, Sebelius criticized the nation's largest insurance companies for raising premiums on customers who buy individual policies. She argued that premiums have contributed to "excessive" insurer gains.
The administration's stance could set the stage for a political showdown, with Democrats struggling to enact the president's top domestic priority and Republicans trying to block what many conservatives see as government overreach.
Democratic congressional leaders have nearly finished efforts to reconcile the two health bills the House and Senate passed separately last year with practically no Republican help, a senior administration official said.
Obama will use their legislation to expand coverage to 30 million and require most Americans to carry insurance as the basis for a proposal that the White House will post online by Monday, three days before the Feb. 25 summit, said the official, who spoke on the condition of anonymity to discuss private negotiations.
Obama says he is open to Republican ideas for changing the healthcare system. But many Democrats seriously doubt that GOP leaders will support compromises that could draw enough lawmakers from both parties to create a bipartisan majority.
If next week's meeting does not break the logjam, congressional Democrats will face a tough choice. They can pass a highly diluted healthcare bill or nothing at all, which would send them into the November elections with a high-profile failure despite their control of Congress and the White House.
Or they can use an assertive and contentious tactic, known as reconciliation, to pass a far-reaching healthcare bill in the Senate without having to face GOP delaying tactics. Democrats lost their ability to block filibusters when Massachusetts Republican Scott Brown won a Senate seat last month.
Both parties have used reconciliation rules in the past. But Republicans have practically dared Democrats to do so on healthcare, citing polls showing significant opposition to the legislation.
It's unclear whether the House or Senate can muster the necessary votes. Democrats, who hold 255 of the House's 435 seats, drew only one GOP ally when the House passed its healthcare bill, 220-215, in November. Since then, one Democrat who voted for the bill has resigned, one has died, and a third plans to leave office Feb. 28. Moreover, changes meant to meet Senate demands could peel away enough liberals on one end, and party centrists on the other, to cause the revised bill to fail.
In the Senate, Democrats control 59 seats, and reconciliation rules require only a simple majority. But several Democratic senators have expressed discomfort or outright opposition to using the rules to thwart filibusters on healthcare.
House Republican Leader John Boehner of Ohio said Thursday, "A productive, bipartisan conversation on healthcare starts with a clean sheet of paper."
Boehner's office labeled next week's meeting the "summit of all fears."
But at least one moderate Republican was optimistic about the session.
Sen. Susan Collins of Maine said that, if the summit succeeds, a bipartisan bill could be put together and passed within six weeks.
"My advice to our Republican leadership is we should view this as a good-faith effort and go in there with a consensus list of provisions that we could support and that would make a difference," she said in an interview with The Associated Press.
House Democrats are insisting on several changes to the bill the Senate passed on Christmas Eve, before Brown was elected to succeed the late Sen. Edward M. Kennedy. The changes include reducing or eliminating a proposed tax on generous employer-provider health plans, and eliminating a Medicaid subsidy aimed only at Nebraska.
Also, some House Democrats who oppose legalized abortion are demanding that the Senate's more permissive language on the topic be replaced by the House provisions. It was unclear Thursday how that might be achieved.
The cost of the legislation — about $1 trillion over 10 years — would be paid for through Medicare cuts and a series of tax increases. House officials said Democratic leaders are not yet pressing wary colleagues to back a healthcare bill under the special procedural rules. That could happen soon, however, if next week's summit fails to produce a bipartisan breakthrough.
House congressional aides said they expect leaders such as Speaker Nancy Pelosi, D-Calif., to tell colleagues that using all their parliamentary muscle to pass a healthcare bill — even if it triggers withering criticism from the right — is preferable to facing voters empty-handed this fall.
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