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Health Timeline on Life Support

Correction Appended

With prospects slipping for Senate action on health care this month, House Democrats are lowering expectations that they will move their own version of a sweeping overhaul before taking off for a monthlong August recess.

But even as House Democratic leaders dial down hopes for quick action, the White House and top Democrats are trying one last push to get the bill done.

House Energy and Commerce Chairman Henry Waxman (D-Calif.) was plunging ahead with efforts to strike a deal with the moderate Democrats who have forced the package to a standstill over concerns about its scope and cost. And White House Chief of Staff Rahm Emanuel, budget director Peter Orszag and top health negotiator Nancy-Ann DeParle were working to win over dissident Blue Dog Democrats.

The legislative brinksmanship was playing out Monday evening as Waxman’s committee resumed its markup. The panel is the last of three to approve the measure, and, owing to its bloc of eight Blue Dogs, seven of whom are opposed, is the one that poses the greatest challenge to Democratic leadership.

Committee aides and Blue Dog staffers huddled through the weekend, and Waxman spent hours on Monday afternoon negotiating with Blue Dog lawmakers. But they failed to forge breakthrough agreements on a number of remaining issues: Blue Dogs’ insistence on deeper cost cuts, the shape of a government-backed insurance option, and reimbursement rates for doctors and hospitals.

“We’re hopeful,— said Rep. Mike Ross (D-Ark.), the lead Blue Dog negotiator on health care. “We continue to try and play a constructive role.— But, he cautioned, “we still have a long way to go.—

Ross said the talks focused on outstanding policy differences, but House leaders and negotiators are also weighing political considerations as they eye the slow pace of action in the Senate.

Vulnerable House Democrats want the Senate to go first so they can avoid a repeat of the bruising they suffered over the July Fourth recess after edging a controversial climate change package over the line.

Leaders are getting the message. Speaker Nancy Pelosi (D-Calif.) on Friday signaled that leaders would coordinate action with the Senate. And House leadership aides on Monday said considering the Senate’s slow movement, it is looking increasingly unlikely that the House will vote on a bill before the break.

“My sense is it’s 50/50 right now,— said one leadership aide, who sought to reframe expectations. “Rather than looking at this as the end of the fourth quarter, people need to be looking at it as the end of the second quarter. … There’s still plenty of time to meet the president’s deadline of signing a bill in October. And at the end of the day, that’s the key deadline.—

Another said that leadership “has heard from Members concerns about wanting to be sure the Senate votes as well before we adjourn.—

The growing uncertainty about the timing came in sharp contrast to what House Democratic leaders have promised for the bill.

Just last week, at a press conference to unveil the draft legislation, Waxman said lawmakers could not afford to wait.

“We, quite frankly, cannot go home for a recess unless the House and the Senate both pass bills to reform and restructure our health care system,— he said then.

Monday, Waxman asserted that he wasn’t delaying his markup and would “like to— pass the bill before August. That rhetoric matches that of Senate leaders and the White House, which now has framed House and Senate passage by August as a goal, not necessarily a strict deadline.

But with the Energy and Commerce panel wading back into the thicket of its markup, there were more thorny issues remaining than ready-made solutions. And Blue Dogs weren’t alone in raising concerns. Rep. Bart Stupak (D-Mich.), a moderate who has aligned himself with the Blue Dogs on the panel, said he has been in talks with Waxman about an amendment that would prevent the bill from pre-empting state laws on abortion.

Republicans complained the bill could potentially force states to provide abortion funding for their employees, a situation Waxman called “highly unlikely— and said would probably be addressed by an amendment.

Stupak and six Blue Dogs joined Republicans in adopting an unrelated Republican amendment giving the Health and Human Services secretary the power to eliminate duplicative programs last week on a 29-27 vote, serving notice that they have to be reckoned with.

Coming out of a weekend retreat, the seven Blue Dogs on the Energy and Commerce panel are “attached at the hip,— Ross said.

Ross declined to discuss the specifics of the negotiations but said a public insurance option based on Medicare rates “remains a deal-breaker for us.—

Ross said the talks were mostly about changing the bill rather than timing. But he noted that many House Members are watching to see what the Senate does. “I think as we move to the more controversial parts of the bill, we’d like to have a better idea of what can actually pass the Senate.—

Correction: July 21, 2009

The article misstated the number of Blue Dog Democrats on the House Energy and Commerce Committee. There are eight.

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