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Intensity of Health Care Talks Increases

Health care negotiations in Congress will pick up steam next week, as the House returns for legislative work and Members become more engaged in exploring the compromises necessary to enact a bill this year.Though the Senate will still be in recess until after the Martin Luther King Jr. holiday, Senate leaders, including Majority Leader Harry Reid (D-Nev.), will be back in town by midweek, sources indicated. More immediately, White House, House and Senate staffers are expected to meet throughout this weekend, and conference calls between the president and Congressional leaders are likely, one senior Senate Democratic aide confirmed.While the president has indicated a desire to have a bill completed before his State of the Union address in early February, the senior aide said Reid and Speaker Nancy Pelosi (D-Calif.) are “trying to avoid hard deadlines.— Though Democratic leaders will attempt to work quickly, the aide added that even once a final bill is negotiated between the chambers it would take 10 to 13 days for the Congressional Budget Office to produce an official cost estimate.The president has met or talked to House and Senate leaders and chairmen several times this week, but talks are “still in the feeling-out stage,— said another Senate Democratic aide.This aide said the thrust has been on trying to see what House liberals will accept from the less ambitious Senate bill, but that a certain amount of moaning and groaning from the House is expected before any final deal emerges.“It’s commonly accepted by most folks outside the United States House of Representatives that the Senate threshold is in many ways the maximum of what can get 60 votes— in that chamber, the aide said.But House sources said they feel they may have more leverage than Senate Democrats think.With the House pushing for everything from dramatically scaling back the “Cadillac— tax on insurance plans to having a national health insurance exchange instead of state exchanges, they are pointing to a backlash against Sens. Ben Nelson (D-Neb.) and Joe Lieberman (ID-Conn.) for their roles holding up the health care bill for major concessions.Lieberman’s poll numbers have tanked in Connecticut, with Democrats overwhelmingly unhappy with him, a House leadership aide noted.“Lieberman and Nelson have paid a political price for their overreach, so the playing field is different,— the aide said. “Nobody is going to get all they want.—But the senior Senate Democratic aide said House Democrats are deluding themselves if they think the Senate is in a position to substantially alter its measure, given the need to get 60 votes and the lack of Senate GOP support. That dynamic forced Reid to make some controversial accommodations for a handful of members of the Senate Democratic Conference — including Nelson and Lieberman — in order to get the measure passed on a party-line vote on Christmas Eve.“The reality is that we had no margin for error the last time and that hasn’t changed,— said the senior aide. “With all due respect to the folks in the House, how exactly do they suggest we keep [Nelson’s and Lieberman’s] votes?—Still, House Democrats are pushing for removal of the antitrust exemption enjoyed by health insurers — an item Nelson prevented from being included in the Senate bill — and a boost in affordability credits to the middle class. And they also prefer taxing the rich over the “Cadillac— tax, which a number of House Members complained is unpopular in their districts, particularly in high-cost areas such as the Northeast. That tax also is unpopular with unions, sparking talk of possibly exempting all union health plans. President Barack Obama, who supports taxing high-cost health plans, is expected to meet with union leaders next week to talk about the provision.There also is talk of giving every state the same Medicaid deal Nelson extracted for Nebraska — derided as the “Cornhusker Kickback— — full federal coverage of the cost of the Senate bill’s Medicaid expansion. Nelson has endorsed expanding the provision nationwide, but doing so would push up the price tag and leave less money for affordability credits if the bill is to stay within Obama’s $900 billion, 10-year spending cap for the entire bill.

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