Obama Takes Health Care Deadline to Democrats

Published: March 4, 2010, New York Times

WASHINGTON — President Obama, beginning a full-court press for his health care overhaul, met Thursday with insurance industry executives and House Democrats as party leaders on Capitol Hill struggled to figure out whether they could meet the president’s timetable for enacting legislation within a few weeks.

One day after Mr. Obama vowed to do “everything in my power” to get a bill passed, his health secretary, Kathleen Sebelius, convened insurance executives at the White House and pressed them to release actuarial data justifying their rate increases. The president stopped by — an appearance that was unscheduled, but clearly orchestrated — to deliver a letter from an Ohio cancer survivor who had dropped her insurance after a 40 percent rate increase.

The president spent the afternoon in back-to-back private sessions with two separate groups of House Democrats: liberals and members of the various minority caucuses, many of whom are uncomfortable with the bill because it lacks a “public option,” or government-backed insurance plan; and leaders of the centrist New Democrat Coalition.

He told the liberals that a public option would never pass the Senate, but said he would be “personally committed” to pursuing it once the current bill became law, said Representative Raúl Grijalva, Democrat of Arizona and co-chairman of the Congressional Progressive Caucus. He asked centrists for support.

“The president impressed upon us the need to pass comprehensive health care reform and do it soon,” Representative Joseph Crowley, the New York Democrat who leads the centrist coalition, said after the meeting, adding, “I think when all is said and done, we will have the votes.”

A big question, though, is precisely when all might be said and done. Mr. Obama’s press secretary, Robert Gibbs, told reporters Thursday that the president expected the House to complete its work by March 18, when Mr. Obama is to leave for Australia and Indonesia. But the House speaker, Nancy Pelosi, and other Congressional leaders outlined steps that would make it difficult to meet that timetable.

First, Ms. Pelosi said, Democratic leaders must agree on the substance of a budget reconciliation bill, the likely vehicle to make changes in the health care bill passed by the Senate. At that point, Ms. Pelosi said, House Democratic leaders will consult with their Senate counterparts, and then their own colleagues in the House. She conceded that some Democrats are skittish.

“Every vote, every legislative vote is a heavy lift around here,” Ms. Pelosi said.

Many House members seemed to be keeping their options open. Representative Bart Stupak, the Michigan Democrat and author of restrictive anti-abortion language that is not in the Senate bill, said in an interview with Fox Business Network that he did not oppose the use of reconciliation per se. But he also said Mr. Obama needed to be “more flexible” in tightening the abortion restrictions.

“I want to see health care pass, and whatever vehicle we need to do it, let’s get it done,” Mr. Stupak said. “But there’s a principle and a belief that the American people agree with, which says no public funding for abortion, and that’s a principle and a belief I’ll continue to fight for.”

Ms. Pelosi said the Senate health bill should be acceptable to the House, with fixes to be made in the budget reconciliation bill: additional subsidies, to make insurance more affordable for moderate-income people; elimination of a special Medicaid deal for Nebraska; and a reduction in a proposed excise tax on high-cost health plans offered by employers.

While Ms. Pelosi said 80 percent of the excise tax would be eliminated, some Democrats remain unhappy with it. Representative Dan Maffei, Democrat of New York, warned that the tax “would still hit middle-income people in my district.”

Another New York Democrat, Representative Jerrold Nadler, said Ms. Pelosi told skeptical Democrats, “When you win 80 percent, take your victory.”

In the Senate, Republicans said Thursday that Mr. Obama was making a big mistake if he assumed that the Senate would approve, without change, a budget reconciliation bill passed by the House. Senator Lamar Alexander of Tennessee, the No. 3 Republican in the Senate, said his colleagues would offer numerous amendments to the budget bill, in an effort to “stop it.”

At the White House, participants said the tenor of the meeting between Ms. Sebelius and the insurance executives was surprisingly cordial. Mr. Obama and Ms. Sebelius have been excoriating insurers in public. But the executives said the meeting was civil and focused on health policy and economics, not politics.

Two chief executives — Stephen J. Hemsley of UnitedHealth and Angela F. Braly of WellPoint — said they had made the case that premiums were higher because they must pay the higher prices being charged by doctors, hospitals and makers of drugs and medical devices. The executives also told the White House that their profit margins were smaller than those in other sectors of the health industry.

“If you took all the profits of the seven largest commercial health insurance companies, they would pay for just two days of health care for the uninsured,” David M. Cordani, the chief executive of Cigna, said in an interview after the session.

Mr. Gibbs, though, suggested the president took a skeptical view in his talk with the executives. “The president said, ‘Look, I understand. I realize costs are going up, but it is unjustifiable to raise health insurance rates at such a drastic — to such a drastic level when health care inflation is not at that level,’ ” Mr. Gibbs said, recounting the conversation.

The White House meeting might not have produced any agreement between Mr. Obama and the insurers, but it did result in some mini-celebrity for the cancer survivor who wrote to the president.

She is Natoma Canfield, 50, of Medina, a town outside Cleveland. She has been cancer free for 11 years, but wrote Mr. Obama on Dec. 29 to say that last year, though she increased her deductible to the highest level available, she paid more than $6,075 in premiums, while her insurer paid just $935 in reimbursements. When told that the policy would cost nearly $8,500 this year, she dropped it; in a phone interview, she said she works cleaning houses and could not afford the policy. The White House released her letter, and Mr. Obama’s reply; by Thursday evening, she said, she was swamped with inquiries from reporters.

“I just wanted someone to have it known that I was for health care and that something needed to be done,” she said. “I never expected the president to read it himself.”