In a meeting at the White House, Obama expressed his preference for the insurance tax contained in the Senate's health overhaul bill, but largely opposed by House Democrats and organized labor, Democratic aides said. The aides spoke on condition of anonymity because the meeting was private.
House Democrats want to raise income taxes on high-income individuals instead and are reluctant to abandon that approach, while recognizing that they will likely have to bend on that and other issues so that Senate Majority Leader Harry Reid, D-Nev., can maintain his fragile 60-vote majority support for the bill.
House Speaker Nancy Pelosi and four committee chairmen met with the president Wednesday as they scrambled to resolve differences between sweeping bills passed by the House and Senate. The aim is to finalize legislation revamping the nation's health care system in time for Obama's State of the Union address early next month.
Special Report: Health Care Reform
Despite the dispute over the payment approach, Pelosi, D-Calif., emerged from the meeting expressing optimism.
"We've had a very intense couple of days," Pelosi said. "After our leadership meeting this morning, our staff engaged with the Senate and the administration staff to review the legislation, suggest legislative language. I think we're ."
Congressional staff members stayed at the White House into the evening to continue work, and a conference call of the full House Democratic caucus was scheduled for Thursday. Obama is taking a more direct role than ever, convening Oval Office meetings Tuesday and Wednesday of House Democratic leaders.
The closed-door, Democrat-only approach to the reconciliation of the House and Senate bills represents an abandonment of an oft-repeated campaign promise made by Mr. Obama as presidential candidate, .
Candidate Obama regularly promised to broadcast all such negotiations on C-SPAN, putting the entire process of pounding out health care reform out in the open. (That promise applied to the now-completed processing of forging House and Senate bills, too.)
Back when Republicans controlled Congress and George W. Bush was in the White House, it was Democrats who angrily complained about secret backroom deals.
Now the roles are reversed, says Reid.
"The negotiations are obviously being done in secret and the American people really just want to know what they are trying to hide," said Rep. Tom Price, R-Ga.
The House and Senate bills are alike in many ways. Both impose first-time requirements for almost all Americans to purchase health insurance, providing subsidies for lower- and middle-income people to help them do so, though the subsidies in the House bill are more generous. Both establish new marketplaces called exchanges where people can go to shop for and compare health insurance plans. Both would ban unpopular insurance company practices including denying coverage to people with pre-existing health conditions.
Differences include whom to tax, how many people to cover, how to restrict taxpayer funding for abortion and whether illegal immigrants should be allowed to buy coverage in the new markets with their own money. The House bill covers about 36 million uninsured Americans over 10 years, costing more than $1 trillion, while the cheaper Senate bill covers about 31 million.
House Democrats are steeling themselves to abandon establishment of a new government insurance plan opposed by moderates in the Senate, but in return hope to get the Senate to rescind insurers' antitrust exemption, make subsidies more affordable and agree to establishment of national rather than state health insurance exchanges, among other things. Obama has signaled his support for the House position on the subsidies and other areas, aides said.
The difference in how the bills are paid for is emerging as among the toughest disputes.
The House wants to increase income taxes on individuals making more than $500,000 and couples over $1 million, which would raise $460 billion over 10 years to pay for the bill. The Senate wants to tax insurance companies on plans valued at over $8,500 for individuals and $23,000 for couples, raising $150 billion. Most analysts say the insurance tax would be passed on to consumers, and organized labor is strongly opposed, as are House Democrats, some of whom contend that the tax would violate Obama's campaign pledge not to tax the middle class.
"We did in our house bill something that protects middle class Americans from having to pay more for health insurance," Rep. Xavier Becerra, D-Calif., a member of the House leadership, said Wednesday. "So far we want to stay to that principle."
House members "have been very clear on that issue and working with the president to stick to what he said when he was campaigning for president, we're trying to make sure this does not affect middle class Americans," Becerra said.
Obama has defended the tax as a way to drive down health costs.
"I'm on record as saying that taxing Cadillac plans that don't make people healthier but just take more money out of their pockets because they're paying more for insurance than they need to, that's actually a good idea, and that helps bend the cost curve," the president said in an interview with National Public Radio just before Christmas. "That helps to reduce the cost of health care over the long term. I think that's a smart thing to do."
In the end the House likely will have to accept the insurance plan tax at some level - say starting with plans valued at $25,000 or more, with carve-outs for certain union professions - but it might not happen without a fight.
A provision in the Senate bill to increase the Medicare payroll tax on high-earners could provide some middle ground, although that measure would raise only $87 billion over a decade.