Wednesday, March 03, 2010

In Final Push, Obama Urges ‘Up-or-Down’ Vote on Health - President Obama called for an up-or-down vote on the health care bill on Wednesday/Obama urge

In Final Push, Obama Urges ‘Up-or-Down’ Vote on Health - President Obama called for an up-or-down vote on the health care bill on Wednesday.
Copyright by The New York Times
Published: March 3, 2010

WASHINGTON — President Obama, making his final push for a health care overhaul, called Wednesday for Congress to set aside political gamesmanship and allow an “up-or-down-vote” on the measure, so that Democrats can pass the legislation and he can sign it into law, after nearly a year of debate.

“I believe the United States Congress owes the American people a final vote on health care reform,” Mr. Obama said in a brief 15-minute speech in the East Room of the White House. He called on Democratic leaders of both chambers to schedule a vote in the next few weeks, adding, “From now until then, I will do everything in my power to make the case for reform.”

Moments after Mr. Obama spoke, the White House announced that he would travel to Pennsylvania and Missouri next week to talk about the health legislation.

Wednesday’s remarks, made to a group of sympathetic medical professionals, many of them clad in traditional white lab coats, marked Mr. Obama’s entry into the end game of Washington’s long and divisive health care debate. With Republicans unified in opposition to the measure, Mr. Obama used his appearance to make the case to the public that while he is willing to accept Republican ideas, starting over, as Republicans are demanding, does not make sense.

He called on Democrats to stick with him.

“This has been a long and wrenching debate,” Mr. Obama said, adding that while health care “easily lends itself to demagoguery and political gamesmanship,” that is no reason “for those of us who were sent here to lead to just walk away.”

In the short 15-minute speech, the president avoided using the word “reconciliation,” the name for the parliamentary tactic that Democrats must now use to avoid a Republican filibuster of the bill. But senior advisers to the president made clear that is his plan.

“This has been laid out in a way that provides us the maximum flexibility to get it done,” Robert Gibbs, the White House press secretary, told a small group of reporters who gathered in his office before Mr. Obama spoke. But reconciliation could prove a heavy lift on Capitol Hill. At a bipartisan health forum at Blair House last week, Mr. Obama laid out an 11-page synopsis of his plan, without providing the House and Senate Democratic leadership with legislative language. It will now be up to Nancy Pelosi, the speaker of the House, and Harry Reid, the Senate majority leader, to produce that language, and then send it to the Congressional Budget Office for an analysis of how much the measure will cost. Getting that done in several weeks, as Mr. Obama says he expects, could prove difficult.

Friday will mark one year since Mr. Obama kicked off his plans for a major health care overhaul, with a high-profile forum at the White House that included lawmakers, insurance industry and hospital executives, medical professionals, representatives of the pharmaceutical industry and others with a stake in the debate.

On Wednesday, after 12 months of legislative hearings, town hall meetings, speeches, polls and debates, Mr. Obama made clear that he expects Democrats to line up behind the plan, no matter how skittish they feel about their re-election prospects in the fall.

“The American people want to know if it’s still possible for Washington to look out for their interests and their future,” Mr. Obama said. “They are waiting for us to act. They are waiting for us to lead. And as long as I hold this office, I intend to provide that leadership. I don’t know how this plays politically, but I know it’s right. And so I ask Congress to finish its work, and I look forward to signing this reform into law.”

Since he convened last week’s forum at Blair House, Mr. Obama has been laying the groundwork for the course he is now pursuing. He concluded the Blair House meeting by saying he was open to incorporating Republican ideas, but that Democrats would go forward on their own if he did not see any evidence of Republican cooperation.

On Tuesday, in a letter to Congressional leaders, Mr. Obama said he was open to pursuing four specific ideas raised by Republicans during the Blair House forum, including establishing “health courts” to resolve medical malpractice claims and encouraging the use by individuals of medical savings accounts that get favorable tax treatment.

But even as Mr. Obama sent the letter, his chief of staff, Rahm Emanuel, and top health policy adviser, Nancy Ann DeParle, went to Capitol Hill to meet with House Speaker Nancy Pelosi and Senate Democratic leader Harry Reid and prepare a final legislative package that they would be able to pass with simple majorities in each house. The leaders are still working on the details of that package. “We’re getting closer,” Jim Manley, Mr. Reid’s spokesman, said shortly before the president’s remarks. He did not elaborate.

With Republicans accusing Democrats and Mr. Obama of trying to ram the bill through Congress, the president and his allies are making the case that in fact, comprehensive health legislation has already passed both chambers, garnering a majority in the House and a supermajority in the Senate. Technically, they say, reconciliation will be used only to pass a small package of fixes to the original bills.

The health bill, Mr. Obama said, “deserves the same kind of up-or-down vote that was cast on welfare reform, the Children’s Health Insurance Program, Cobra health coverage for the unemployed, and both Bush tax cuts,” Mr. Obama said, citing other measures that have been adopted using reconciliation.

Under their tentative plan, the House would first approve the bill that was adopted by the Senate on Christmas Eve. Mr. Reid and Ms. Pelosi would also draft a package of changes to be approved by both chambers in a separate reconciliation bill. The reconciliation package would effectively smooth out some of the differences between the House and Senate versions.

The whole bundle would be sent to Mr. Obama to sign into law.

But while that sounds feasible, carrying out the strategy could yet prove tricky. Senate Republicans could try offering countless amendments as a delaying tactic. And Ms. Pelosi could have difficulty rounding up the necessary votes to pass the reconciliation package in the House, because it will strip out anti-abortion language that some Democrats favor.

Obama urges Congress to 'finish its work' on reform bill
By William Branigin and Michael D. Shear
Copyright by The Washington Post
Wednesday, March 3, 2010; 3:28 PM

President Obama urged Congress on Wednesday to "finish its work" on health-care reform legislation and indicated support for a Democratic legislative strategy that includes a politically risky procedure known as reconciliation.

In a speech at the White House, Obama told an audience of medical professionals that Congress "owes the American people a final vote on health-care reform." He did not mention the reconciliation procedure by name but said the legislation now stalled in Congress "deserves the same kind of up-or-down vote that was cast on welfare reform, the Children's Health Insurance Program, COBRA health coverage for the unemployed and both Bush tax cuts -- all of which had to pass Congress with nothing more than a simple majority."

The programs he mentioned were passed under reconciliation rules, which would enable the Senate to approve a health-care overhaul with a simple majority, rather than a filibuster-proof 60 votes. Obama said he has asked House and Senate leaders to schedule a vote "in the next few weeks."

Republican lawmakers immediately and bitterly blasted Obama's apparent acceptance of the reconciliation procedure and vowed to keep fighting to kill the proposed legislation.

Forging ahead despite the GOP objections, Obama defended health-care reform as crucial to American families and businesses. He said his proposal, projected to cost at least $950 billion over 10 years, would lower skyrocketing costs and end abuses by insurance companies, including discrimination against people with preexisting conditions.

He emphatically rejected Republican demands to abandon existing proposals and "start over" with an incremental approach.

Flanked by doctors and nurses in white coats, Obama said, "I do not see how another year of negotiations would help. Moreover, the insurance companies aren't starting over. They are continuing to raise premiums and deny coverage as we speak. For us to start over now could simply lead to delay that could last for another decade or even more. The American people and the U.S. economy just can't wait that long."

Declaring that "it's time to give the American people more control over their own health insurance," he said his proposal represents "an approach that has been debated and changed and, I believe, improved over the last year." He said it "incorporates the best ideas from Democrats and Republicans," including some that GOP participants offered during last week's "health-care summit," such as funding state grants on medical malpractice reform and curbing waste, fraud and abuse in the health-care system.

"My proposal also gets rid of many of the provisions that had no place in health care reform -- provisions that were more about winning individual votes in Congress than improving health care for all Americans," Obama said.

At stake is not only Washington's ability to resolve the health-care issue, "but our ability to solve any problem," Obama said. "The American people . . . are waiting for us to act. They are waiting for us to lead. And as long as I hold this office, I intend to provide that leadership. I don't know how this plays politically, but I know it's right. And so I ask Congress to finish its work, and I look forward to signing this reform into law."

In response to the speech, Sen. John Cornyn (R-Tex.) said Obama embraced "the hyper-partisan reconciliation tactic" despite previous pledges of transparency and statements that health-care reform should not be passed in the Senate with just 51 votes.

"The American people have made it abundantly clear that they do not want a job-killing, one-size-fits-all, $2.3 trillion dollar, Washington takeover of our health care system," Cornyn said in a statement. "Instead, they want a step-by-step approach that tackles the real problems in our health care system."

House Minority Leader John A. Boehner (R-Ohio) said Obama "voiced support for a partisan scheme to jam the bill through Congress" while trying to "get away with sprinkling a few sensible Republican proposals onto a fundamentally-flawed 2,000-page bill."

He added: "Americans do not want a trillion-dollar government takeover of health care stuffed with tax hikes, Medicare cuts, and giveaways to Washington special interests. . . . They know that the president's job-killing health care plan would put bureaucrats in charge of medical decisions. . . . That's why they want us to start over with a clean sheet of paper and step-by-step common-sense reforms to lower health care costs."

Asserting that "this debate is far from over," Boehner said, "The final battle will be in the House of Representatives, and if the American people stay engaged, we can win this fight."

Before Obama spoke, senior aides made it clear that the White House would launch an aggressive, final push for health-care reform during the next several weeks.

"Whatever it takes to get health care done" said Press Secretary Robert Gibbs. Asked what Obama wants done in that period, Gibbs said: "the whole thing getting done."

That new public push is scheduled to begin Monday with a presidential trip to Philadelphia and another on Wednesday to St. Louis. The White House described the visits as opportunities for Obama to discuss health-insurance reform.

But White House advisers are already trying to turn up the heat on Republicans who oppose reconciliation, accusing them of flip-flopping by supporting the procedure when it helps them and opposing it when it does

"Republicans were for reconciliation before they decided they were against it," Gibbs told reporters.

In his speech, Obama rejected the idea of "government-run health care" in the United States as "neither practical nor realistic," and he similarly spurned what he described as the Republican approach to "loosen regulations on the insurance industry," giving it "even freer rein to raise premiums and deny care."

He said his proposal would "end the worst practices of insurance companies," including dropping coverage when people get sick and "arbitrarily and massively" raising premiums. And he stressed that "our proposal is paid for" and would reduce health-care costs for millions of people, businesses and the federal government.

While a leading Republican proposal would extend coverage to only 3 million uninsured Americans, Obama said, his approach would cover more than 31 million. He emphasized that key elements of the plan are interrelated, saying that "health reform only works if you take care of all these problems at once."

The complex, wrenching issue of health-care reform "easily lends itself to demagoguery and political gamesmanship, misrepresentation and misunderstanding," Obama said. "But that's not an excuse for those of us who were sent here to lead to just walk away. We can't just give up because the politics are hard."

Dismissing speculation about the effort's impact on future elections, he said he would leave it to others to "sift through the politics, because that's not what this is about."

The House and Senate passed separate health-care reform bills last year, but the process of reconciling them has stalled, in part because the election of a Republican senator in Massachusetts in January ended the 60-vote Senate majority won by Democrats in the 2008 elections.

In an effort to move the process forward, Obama last week held a bipartisan health-care summit with key lawmakers and urged Republicans to "do a little soul-searching" on measures they would accept to address the core problems of covering more than 30 million Americans without health insurance and requiring insurance companies to cover those with preexisting conditions. However, Republicans maintained their position that the proposed legislation represents a "government takeover" of health care, and they demanded that it be scrapped entirely in favor of starting from scratch.

Obama rejected the GOP prescription in a letter to congressional leaders Tuesday. "Piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs," he wrote. "Both parties agree that the health care status quo is unsustainable. And both should agree that it's just not an option to walk away from the millions of American families and business owners counting on reform."

He said he was open to several Republican proposals offered at the health-care summit with the aim of lowering health costs while making coverage more affordable. The proposals include expansion of health savings accounts, permitting insurance companies to sell high-deductible policies through new state-run insurance exchanges, stepping up efforts to root out fraud in Medicare and Medicaid, funding state projects aimed at averting medical malpractice lawsuits, and finding a "fiscally responsible" way to increase payments to doctors who treat Medicaid patients.

Under the White House strategy, the House would adopt the bill the Senate passed on Christmas Eve and approve a separate package of fixes to reflect a compromise worked out between Democrats in the two chambers. Invoking reconciliation rules for budget provisions would mean that the fixes could not be filibustered, and Senate Democrats could approve them with a simple majority vote, possibly sending the package to Obama for signature before Congress's Easter recess begins March 29.

The reconciliation procedure was created in 1974 to help lawmakers advance politically difficult budget legislation, particularly measures that reduce the deficit. Both parties have used it a total of at least 22 times since 1980 to push through a variety of policies, including creating COBRA health benefits in 1986 for people who lose their jobs, overhauling the welfare system in 1996, and passing President George W. Bush's two huge tax-cut packages in 2001 and 2003.

Staff writers Lori Montgomery and Shailagh Murray contributed to this report.


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