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Democrats Seek Handle on Health

House Democratic leaders sought to regain momentum for their health care overhaul Monday after getting tripped up by internecine fighting.

But even as Speaker Nancy Pelosi (D-Calif.) sought to put a sunny face on the legislation, she confronted fresh concerns from another large bloc of Democrats worried about the public insurance plan at the heart of the bill.

And Democrats also were clamoring for cover from President Barack Obama before they are asked to vote for a big tax increase to pay for the restructuring of the health system.

New Democrats added their voice to the conservative Blue Dogs in a letter to leadership that slammed plans to use Medicare reimbursement rates as the basis for such a plan.

“Any public option that reimburses providers based on Medicare will ultimately undermine the ability of patients to receive their choice of care,— the letter states.

Blue Dog Rep. Mike Ross (D-Ark.) has called the issue of Medicare rates a deal-breaker for most Blue Dogs, arguing that regional disparities must be addressed first to ensure access to doctors, particularly in rural areas. But the liberal Progressive Caucus is demanding a Medicare-like public plan that is available to anyone.

Pelosi said the ongoing discussions were part of the legislative process and that the bill would continue to be refined.

She sought to deflect criticism by arguing the bill would lower costs and enhance coverage for the middle class, and she defended a proposed tax increase on the rich to pay for it.

“Middle-income people are not touched— by the tax increase, she said at a press conference that featured a coffee shop owner, an unemployed couple and a senior on Medicare who said they would benefit from the bill.

The Democratic bill would provide a host of benefits for middle-class people, including eliminating rules on pre-existing conditions and the fear that they would lose their insurance if they lose their jobs, Pelosi said.

“This is about the middle class in our country,— she said. “Lower their costs, improve their quality, expand their coverage and do so in a way that gives them piece of mind. … This is about them.—

House Ways and Means Chairman Charlie Rangel (D-N.Y.) said last week that the tax increase would raise $540 billion over a decade and would affect families making more than $350,000 a year starting in 2011.

Meanwhile, Democrats are eager for cover on how to pay for the bill from Obama, who met late Monday with top House and Senate Democrats to discuss the health care overhaul.

“We’ve seen on other bills the president’s not been fully engaged, and he’s really got to be engaged right now,— said one top Democratic aide. “We really need the president to weigh in or we’re going to keep getting pummeled by Republicans.—

But the aide predicted that the tax hike should be broadly acceptable to the Democratic Caucus because it is similar to other tax hikes voted on during the previous Congress and mirrors the platform many Democrats campaigned on.

A White House aide stopped short of endorsing the House tax hike Monday but called it one of “several good ideas on the table— that would only affect “the very wealthiest Americans.—

The aide noted that Obama has proposed limiting the tax break on itemized deductions enjoyed by the wealthy, and he prefers that most of the funding come from cutting waste instead of new revenues.

Democratic leaders said their bill — which could be released as early as today —would be marked up this week in House committees and passed out of the chamber later this month; they argued it would improve quality, reward prevention and dramatically expand insurance coverage.

The bill would eliminate the “doughnut hole— in the Medicare prescription drug benefits and provide large tax breaks to small businesses, Democratic leaders said.

Republicans have slammed the proposed tax increase as damaging to the economy and have attacked the overall package as a government takeover of health care.

The Senate, however, put the kibosh on past attempts to raise taxes on the wealthy, and may do so again. Senate Democrats declined to endorse the idea on Sunday talk shows and are looking at a host of alternative tax hikes to help pay for their plan.

With fresh urging from Obama, Senate Democratic leaders continue to cling to a timeline that calls for passing a bill out of the chamber before Congress adjourns for the August recess, even as key Democratic and Republican Senators said over the weekend that the deadline would likely be missed.

The Health, Education, Labor and Pensions Committee continued Monday to mark up its health care reform bill, with the Finance Committee taking a break from marathon negotiations on its bill in large part because of the kickoff of Sonia Sotomayor’s Supreme Court confirmation hearing.

While HELP since late June has been marking up a decidedly liberal bill that has the unanimous support of the committee’s Democrats and no backing from the panel’s Republicans, Finance has remained committed to reaching a bipartisan deal.

Finance had planned to begin marking up its bill in late June, but after missing that deadline, Chairman Max Baucus (D-Mont.) has declined to set a new date.

David M. Drucker contributed to this report.

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