President Obama declared the health care debate over on Wednesday and urged congressional Democrats to take the politically risky step of pushing his newly written compromise reform bill through using a controversial tactic to circumvent a Republican filibuster.
Calling for an “up-or-down” vote, Mr. Obama offered to add a few Republican ideas to the $1 trillion bill, but made clear that the time for talk was over.
“Every idea has been put on the table; every argument has been made,” Mr. Obama said in a speech before an audience of health care professionals in the East Room of the White House. “So now is the time to make a decision about how to finally reform health care so that it works, not just for the insurance companies, but for America’s families and businesses.”
Republicans scoffed at Mr. Obama’s tough talk, vowing to fight the effort at every turn and to tap the American public’s distaste for the measure in the midterm elections.
“They’re making a vigorous effort to try to jam this down the throats of the American people, who don’t want it,” said Senate Minority Leader Mitch McConnell, Kentucky Republican.
“We think that’s a policy mistake, and we think resorting to these kinds of tactics, to thumb your nose at the American people, is something that ought to be resisted,” Mr. McConnell added.
At stake is the biggest policy initiative of the year-old Obama presidency, a rewrite of the nation’s health care system that would trim hundreds of billions of dollars from Medicare, expand Medicaid, mandate that every American join a plan and rewrite rules telling insurance companies how they can operate.
The House and Senate have passed their own versions of bills, but the debate has been stalled for nearly two months after Democrats lost their filibuster-proof majority in the Senate in January.
Now, Democrats are looking to turn to a complex budget procedure known as “reconciliation,” under which legislation can pass the Senate with 51 votes rather than 60.
Though congressional Republicans used the tactic when they were in power to pass tax cuts under the George W. Bush administration as well as welfare reform under President Clinton, they have vehemently opposed its use on health care, saying the American people have spoken out against the bill in a number of opinion polls as well as a spate of recent elections.
Mr. Obama did not use the term “reconciliation,” instead referring to the process as a way to secure a vote by a “simple majority.” Mr. Obama had previously been critical of using reconciliation and has said it should not be used on a major effort such as health care.
Even using the parliamentary tactic doesn’t ensure passage of Mr. Obama’s signature legislative effort.
House Speaker Nancy Pelosi, California Democrat, and Senate Majority Leader Harry Reid, Nevada Democrat, say they will be able to round up the votes, but it’s not clear how. In the House, where a bill passed by a narrow margin last year, several Democrats who voted for it have since said they’re reluctant to use reconciliation and that they object to portions of the Senate bill that Mr. Obama wants lawmakers to adopt.
In particular, a group of pro-life Democrats says the Senate text - upon which Mr. Obama’s proposal is based - is not strict enough to prevent federal dollars from going toward abortion.
Democratic leaders also are asking their members to go against the majority of voters, who polls show are leery of the price tag and its long-term impact on their health care and their own budgets. Republicans are fully united against it, and the lone Republican to vote for the plan initially, Rep. Anh “Joseph” Cao of Louisiana, now opposes it.
Dismissing Republican calls to restart the process, Mr. Obama has spent the past two weeks preparing the American public for another battle in the yearlong effort that stalled in the wake of Scott Brown’s unexpected victory in January for a Senate seat from Massachusetts. His victory gave Republicans the votes needed to sustain a filibuster of the overhaul in the Senate, and left Democrats scrambling for a way forward.
Last week, Mr. Obama for the first time offered his own blueprint that tracks closely with stalled congressional efforts. The $1 trillion, 10-year plan includes many of the ideas in the previous bills, such as insurance industry reforms, a requirement that nearly all Americans carry coverage, the creation of state-based insurance exchanges and incentives for employers to provide coverage.
On Wednesday, Mr. Obama challenged Republicans to vote against his plan - which appeared to differ only slightly from the proposal he unveiled last week - saying they should do so if they support less regulation of the insurance industry, which Democrats have repeatedly held up as the chief antagonist in the nation’s health care system.
He also took aim at the minority party for advocating an incremental approach, contending that only a comprehensive bill could bring down health care costs and improve quality.
Mr. Obama’s proposal threw a few bones to Republicans by including ideas on combating waste and fraud, as well as additional funding for state pilot projects aimed at resolving malpractice cases outside of court.
In addition, he said that he took out two of the special carve-outs, for Florida and Nebraska, which he acknowledged were included only to secure votes from those states’ Democratic senators. However, he left in the $300 million for Louisiana that Sen. Mary L. Landrieu secured to help the state cover Medicaid costs.
Republicans have vowed to make every election race this fall a referendum on the health care reform bill, but Mr. Obama on Wednesday urged his colleagues not to consider the political consequences of their votes.
“We can’t just give up because the politics are hard,” he said. “I do not know how this plays politically, but I know it’s right.”
Mrs. Pelosi said Mr. Obama’s speech Wednesday, to a room that included doctors in lab coats, was “a call to action.”
She said that by including some ideas Republicans mentioned in last week’s health care summit at the White House, Mr. Obama has produced a bipartisan effort, even if it doesn’t win any Republican votes.
But Mrs. Pelosi said they’re also confident voters will see “there are key differences between our two parties.”
“Democrats believe we must hold insurance companies accountable in order to rein in premiums, insure 30 million more Americans, and protect patients and consumers nationwide. Congressional Republicans disagree.”
• Jennifer Haberkorn contributed to this report.