President Barack Obama and congressional Democrats, holding out little hope for Thursday's televised bipartisan summit on healthcare, are prepared to try for a far-reaching bill in the coming weeks without a single Republican vote.
Barring an unexpected two-party breakthrough at the summit, Democratic leaders feel they can't afford to fail, leaving them empty-handed on a huge priority in an already difficult election year. It's far from clear they can gather the votes, however, and it will take a major effort to unite fractious Democrats.
A bipartisan compromise seems highly unlikely, members of both parties said Wednesday. Popular insurance reform measures, which Republicans might support, require Democratic-backed measures the GOP staunchly opposes, such as government subsidies to enable millions of low-income Americans to buy health coverage.
With Democrats unwilling to start from scratch, "I think it's nearly impossible to imagine a scenario under which we could reach an agreement," said Senate Minority Leader Mitch McConnell, R-Ky., who will attend the televised six-hour meeting across from the White House.
Given such comments, Democratic leaders say they hope to persuade House Democrats to swallow their objections and approve a health bill the Senate passed on Christmas Eve. In return, Senate Democrats would have to agree to make various changes to health care laws under budget reconciliation rules, which bar GOP delaying tactics.
"Tomorrow we'll have that meeting .... But far more important after that meeting, you can either join us or get out of the way," Sen. Chris Dodd, D-Conn., said at a rally Wednesday.
Said Rep. Henry Waxman, D-Calif., "If the Republicans refuse to support the end of debate so that a majority can work its will we're fortunate enough to have a process so the majority can work its will through the reconciliation activities."
While deriding the summit, Republicans plan to focus on six main areas, according to congressional aides: state incentives to lower costs; making insurance affordable to those with pre-existing conditions; purchasing health insurance across state lines; ending frivolous lawsuits; small business health plans and expanding health savings accounts.
Democrats control 59 of the Senate's 100 seats, one vote short of the number needed to stop GOP filibusters. Republicans strenuously oppose using the reconciliation strategy, but Democrats note the GOP has used it for major legislation in years past.
The House in November passed its version of the healthcare overhaul 220-215, with 39 Democrats abandoning their party's leaders. Those leaders now fear they will lose even more votes over an abortion dispute, and it's unclear whether they can persuade enough of the 39 to come on board to make up the difference.
Democrats easily came together on one of the more popular healthcare issues Wednesday, as the House voted overwhelmingly to repeal the health insurance industry's exemption from federal antitrust oversight. The vote gave Democrats a win on the eve of the summit.
The 406-19 vote was part of a multipronged attack by Democrats against the unpopular industry. At a contentious House hearing, Democrats confronted executives of one company that has sought rate increases of up to 39 percent in California and accused them of purging their sickest customers while spending millions on exorbitant salaries and retreats at ritzy resorts for executives.
And Health and Human Services Secretary Kathleen Sebelius wrote to the heads of five major insurance companies asking them to meet with her to justify their pricing policies.
All three moves were more symbolic than substantive, but together they underscored how Democrats view attacks on the widely disliked health insurance industry as one way to revive support for their healthcare drive, both with the public and among their own lawmakers.
"Health insurance premiums continue to spiral ever upward each year. The copayments and deductibles keep taking further bites out of tight family budgets," said Judiciary Committee Chairman John Conyers, D-Mich., as the House debated the antitrust bill.
The legislation passed Wednesday would put insurers under federal antitrust jurisdiction by amending a 1945 law that gave states, not the federal government, the authority to regulate competition issues within the insurance industry.
Independent experts largely agree that the change would have minimal effect, in part because of the regulatory role states already play. The Congressional Budget Office has said that removing the antitrust exemption would have "no significant effects" on premium prices or the federal budget.
The powerful health insurance lobby America's Health Insurance Plans did not make defeating the bill a priority and Republicans criticized the legislation as ineffectual. Rep. Lamar Smith, R-Texas, said the bill had "all the substance of a soup made by boiling the shadow of a chicken."
The legislation faces dim prospects in the Senate.
Even as the House debated the antitrust bill, executives of WellPoint Inc. were under fire from the House Energy and Commerce Committee. Chairman Henry Waxman, D-Calif., said his panel's investigators had received internal company documents showing that in 2008, 39 company executives received salaries of $1 million or more. And in 2007 and 2008, it spent $27 million for executive retreats, which Democrats said included stays at fancy resorts in Hawaii and Arizona.
WellPoint owns Anthem Blue Cross, which wants to raise rates on individual policyholders in California. WellPoint president Angela Braly blamed the increases on the growing price tags for hospital care and pharmaceuticals. She also cited the ailing economy, which has caused many younger, healthier people to save money by dropping coverage, leaving her company covering an older, sicker population.
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