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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.

House Speaker Nancy Pelosi, California Democrat, promised to reform the nation's health care system soon but said it wouldn't be easy.

"Every legislative vote is a heavy lift around here," she told reporters last week. "Assume nothing as to where we were before and where people may be now. We start, one, two, three, four, all the way up to a majority vote."

Rep. Chris Van Hollen, Maryland Democrat, said on Sunday's political talk shows that passage is uncertain. "Do we have a mortal lock? No," he said, though he repeated that he does "believe it will pass."

"I think the trend is in the right direction because people see that the status quo is absolutely broken," he told CNN's "State of the Union," adding that his party caucus wants to see how the Congressional Budget Office analyzes a final plan's fiscal impact before committing to any votes.

The abortion issue threatens to untie support in the House as well. A dozen Democrats who voted for the House bill, led by Rep. Bart Stupak of Michigan, say the Senate bill would allow for federal funding of abortion and won't support it. The group proved its strength when it inserted strong restrictions into the House bill.

These Democrats say the Senate plan would allow federal funding to cover community health care centers that provide abortions and allow tax subsidies for insurance plans that cover the procedure.

Underlying the policy differences is the House's skepticism of the Senate.

The House has passed nearly 300 bills during this session of Congress that are still waiting for consideration by the Senate. Some of the bills, including a cap-and-trade proposal to curb greenhouse gas emissions, were approved with votes that were politically risky for House Democrats.

Under the president's plan, the House would pass the Senate bill and then a companion bill that repairs the Senate's plan would be introduced into both chambers. In the Senate, it would have to pass under complex budget reconciliation rules.

Senate Republicans are threatening to make that process more complex in attempt to increase the wedge among skeptical House members. Republicans in the House and Senate have said they plan to make health care reform a central issue in the November elections.

The American public largely favors many of the proposed reforms but has grown frustrated with the process.

Twenty-five percent of respondents in a CNN poll conducted in mid- to late February said Congress should pass a bill along the lines of what already has been proposed. That is down from 30 percent a month earlier.

Proposals that have majority of public support include those requiring large and midsize businesses to provide insurance to employees (72 percent), preventing insurance companies from denying coverage for pre-existing conditions (58 percent) and the public insurance plan (51 percent) that liberals favor but Mr. Obama removed from his plans.

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