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Obama’s health care prescription a problem for Congressional Democrats

WASHINGTON – Taken off guard, Democrats at work on health care legislation are grappling with President Barack Obama’s nationally televised insistence on immediate access to insurance for those with pre-existing medical conditions, as well as richer Medicare prescription drug benefits than originally envisioned.

Additionally, Obama’s pledge to hold the overall cost of legislation to about $900 billion over a decade has spread concern among House Democrats, who have long contemplated a costlier measure.

Yet another late complication, according to several Democrats, is the president’s statement that he will not sign a bill ‘if it adds one dime to the deficit, now or in the future, period. And to prove that I’m serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize.’

The $900 billion target is ‘very difficult,’ Rep. Charlie Rangel, D-N.Y., chairman of the House Ways and Means Committee, told reporters. ‘This is reducing coverage for poor and working people.’ He spoke of other ‘restrictions the president has given in his speech.’

Obama outlined his conditions in last week’s speech and an accompanying fact sheet posted on the White House Web Site as Democrats point toward votes in the House and Senate this fall.

After months of bipartisan negotiations, Sen. Max Baucus, D-Mont., chairman of the Finance Committee, told associates during the day he intends to unveil a detailed outline of legislation on Wednesday and convene the panel next week to vote on it.

Despite numerous gestures to Republicans, there were clear indications that Baucus had fallen short in his quest to assemble a coalition of senators from both parties behind his plan.

Baucus’ proposal is certain to shun the liberals’ call for the government to sell insurance, and rely instead on co-ops to offer coverage in competition with private industry. His approach includes a requirement for individuals to buy insurance, with financial penalties for those who don’t. Rather than a mandate for larger businesses to provide coverage for employees, they would be required to defray the cost of any government subsidies their employees would qualify for.

‘I fully expect Republican support coming out of committee,’ he said, but other Democrats said they believed Sen. Olympia Snowe, R-Maine, would be the only one of the panel’s 10 GOP members to vote for the package. Sens. Charles Grassley of Iowa and Mike Enzi of Wyoming have also been involved in the marathon negotiations, but both have raised late objections.

Liberals, too, expressed their unhappiness.

‘The way it is now there is no way I can vote for the package,’ Sen. Jay Rockefeller, D-W.Va., said on a conference call with reporters.

Obama’s decision to detail terms for health care legislation came after months of public deference to lawmakers.

Neither the bill making its way to the House floor nor two companion measures in the Senate included an interim program to assure coverage for consumers with pre-existing medical conditions. Instead, the bills would have waited until 2013, when numerous consumer protections are envisioned.

Sen. Kent Conrad, D-N.D., said the six-member bipartisan group of senators was working at the last minute to meet the president’s request. Another official, who spoke on condition of anonymity, said it involved creation of a high-risk insurance pool, beginning in 2010.

No details were available about costs, either to the consumer or the government.

In the House, a spokesman for the Ways and Means Committee said legislation does not include Obama’s request for immediate availability of insurance for those with pre-existing medical conditions. But lawmakers ‘are currently drafting a provision for inclusion in the final bill,’ the spokesman, Matthew Beck, added in an e-mail.

Officials in both houses said fulfilling Obama’s request on Medicare prescription drug benefits would be considerably more difficult, citing the cost.

The measure Baucus is expected to unveil would cut the so-called ‘doughnut hole’ in half by 2019, but any additional benefit would have to come later, he told reporters.

In the House, Beck said draft legislation called for closing the gap in 15 years, ‘using drug manufacturer rebates to cover the cost.’

Administration officials set the cost of closing the gap at $100 billion over a decade, about $30 billion of which would be picked up by the pharmaceutical industry as part of an agreement announced earlier in the year.

Nearly a week after Obama’s speech, White House aides have not released key details of Obama’s various other proposals, including their cost.

They have yet to explain, for example, whether his no-new-deficit pledge is limited to a one-year time frame, the 10-year period that lawmakers generally use, or a longer period that would greatly complicate efforts to pass legislation that meets his requirements.

Conrad, who is also chairman of the Senate Budget Committee, said he expected a Congressional Budget Office study would show the bill headed for the Finance Committee would reduce deficits over a 20-year period.

Leaders in both houses of Congress have pledged support for provisions that would lead to savings in Medicare over the long term. But as of yet, none of the bills in circulation includes the type of standby cuts that Obama mentioned in his speech last week.

Editor’s note: Associated Press Writers Erica Werner and Charles Babington contributed to this report.

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