WASHINGTON — House Speaker Nancy Pelosi unveiled revised health care-overhaul legislation Thursday that includes a stronger government-operated insurance option than the one that the Senate plans to consider.
Senate Majority Leader Harry Reid, D-Nev., is pushing a government health insurance plan that would allow states to "opt out." Pelosi, D-Calif., is expected to support a public option with no such escape hatch. The revised measure she unveiled merges terms from three separate but similar bills that three committees in the House of Representatives passed earlier.
While Democrats control 256 seats in the House, 38 more than the 218 needed for a majority, the vote to pass the bill is expected to be close, since conservative and moderate Democrats have raised concerns about the measure's cost, tax-raising provisions and an expansion of the role of government. House Republicans uniformly oppose the legislation.
Democratic leaders made some concessions to their restive colleagues, notably that the government plan would negotiate rates with health care providers instead of tying reimbursement to Medicare's rates. Many lawmakers from rural areas and smaller states argued that their providers often are underpaid under Medicare. Reid's Senate plan also would rely on separately negotiated rates.
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Pelosi and her lieutenants plan to meet Thursday morning with House Democrats. Barring any last-minute snag, the speaker intends to announce details of the latest health care measure at the West Front of the Capitol. It's expected to meet President Barack Obama's goal of costing less than $900 billion over 10 years while not increasing the federal budget deficit.
Pelosi e-mailed invitations to the event as she kicks off what's likely to be a quick effort to pass the bill.
Liberals got one major concession: The measure is expected to expand Medicaid, the state-federal program to provide health care to the poor. It would have Medicaid cover those who earn 150 percent of the poverty level, or about $33,000 annually for a family of four, higher than the levels the three House committees had approved last summer.
The proposal also is expected to require employers either to offer coverage to employees or pay penalties, and it would penalize individuals who didn't obtain policies. At least 95 percent of people are likely to get coverage under the measure, up from the current 83 percent.
The bill appears to differ from the Senate version in at least two important respects: It would pay for much of its changes by raising income tax rates on the wealthy, and it wouldn't allow states to opt out of the public plan.
The original House Ways and Means Committee measure imposed tax surcharges on adjusted gross incomes starting at $280,000 for individuals and $350,000 for joint filers.
Pelosi's bill apparently will impose a 5.4 percent income tax surcharge on incomes above $500,000 annually for individuals and $1 million for joint filers.
The Senate proposal has no such surcharge; it's expected to include a tax on higher-end insurance policies. The income tax increase is unpopular among Republicans and some moderate Democrats in both the Senate and the House.
The House is expected to debate the measure next week. Passage could come by the end of the week. The key to Democratic success probably rests with the 52 "Blue Dog" Democrats, conservatives who've long had reservations about the public option.
The three House committees finished writing legislation in late July, and House leaders had hoped to combine their bills and take a final floor vote in September.
Instead, after August featured raucous town hall meetings in some House members' home districts, some Blue Dogs became concerned about backlash, and Democratic leaders struggled to find consensus.
The Senate also is expected to begin debate shortly. Reid said Monday that he was waiting for an analysis of the measure's costs from the nonpartisan Congressional Budget Office before proceeding.
Reid faces problems, since it takes 60 votes to overcome procedural hurdles in the Senate. Though Democrats control 60 seats, up to 12 moderates have voiced reservations about the legislation.
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