Dems’ splintering threatens health bill

The escalating battle among Democrats over abortion has grabbed headlines, but a few other intraparty disputes are endangering President Obama’s proposed health care overhaul.

From stemming rising health care costs and addressing regional disparities on Medicare rates to a general skepticism of the Senate, rank-and-file House Democrats are struggling to support Mr. Obama’s plan as they close in on midterm elections. Voters have become increasingly hostile to the effort.

“Any time the Senate is involved, I become nervous,” said Rep. Emanuel Cleaver II, Missouri Democrat.

Polls show that certain provisions in the Democrats’ plan are popular but that the American public is frustrated with the process, which has included deeply partisan attacks and accusations of legislating state-specific carve-outs in exchange for votes.

It’s unclear how much can be changed from the president’s plan, which is based largely on the Senate bill. Even if Democrats reach compromises on tough sticking points, some provisions can’t be changed if Democrats keep to their plan to wrap up work on health care reform under complex budget reconciliation rules in the Senate.

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Liberal Democrats are disappointed that the president’s plan doesn’t have a public option and say the tax subsidies aren’t generous enough to help the poor and middle class meet the bill’s insurance requirements.

Mr. Obama may have eased some of those concerns in a White House meeting last week when he pledged to try to push through a public insurance plan once he gains momentum with the health care overhaul bill, said Rep. Raul M. Grijalva, Arizona Democrat and co-chairman of the Congressional Progressive Caucus.

Another group of members, largely from the New Democrat Coalition, says the Senate bill doesn’t do enough to repair the broken system that pays physicians and hospitals for treating Medicare patients.

“I’ve always felt that the key to successful health care reform is changing the way we pay for health care, so it’s outcome- and value-based, not volume-based as is fee-for-service today. And I’d like to see more in that direction,” said Rep. Ron Kind, Wisconsin Democrat and one of the lawmakers who met with Mr. Obama last week.

The Senate bill reforms the payment process for physicians but not hospitals or other parts of the health care system, he said.

“The House did a better job of that when we passed our bill,” Mr. Kind said.

Rep. John Adler, New Jersey Democrat, said on “Fox News Sunday” that “I’m not sure we’ve gone far enough in terms of fixing the underlying system to make it affordable for businesses and for taxpayers.”

House members also have taken serious issue with the Senate’s tax on high-cost insurance plans over concern that it would hurt unions, a group loyal to Democrats. The House’s plan instead would increase taxes for Americans with the highest incomes.

Mr. Obama’s plan tried to address that concern by scaling back the tax and delaying the date it takes effect.

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