The White House, Democratic leaders and four fiscally conservative House lawmakers worked out a deal Wednesday to move ahead on sweeping health care legislation.
The deal calls for exempting more small businesses from a requirement to offer coverage, trimming subsidies to help people buy health insurance, and making any government-sponsored insurance plan negotiate payment rates with medical providers instead of dictating them.
The House Energy and Commerce Committee planned to begin work on the bill Wednesday afternoon. Amendments to the legislation would include provisions of the deal. The committee is the last of three in the House to act on the legislation, and Chairman Henry Waxman, D-Calif., hoped to finish by Friday when lawmakers leave for their monthlong August recess.
The House has put off a vote on the overall legislation until September.
The leader of the conservative to moderate Blue Dogs, Rep. Mike Ross, D-Ark., said the deal included:
Exempting businesses with payrolls of $500,000 or below from a requirement to provide insurance to employees or pay a penalty. The existing bill had set the level at $250,000.
The penalty would hit businesses with payrolls between $500,000 and $750,000 on a sliding scale before kicking in fully at 8 percent of payroll.
Poor people would get subsidies to help them buy care after spending 12 percent of their income on premiums, instead of 11 percent in the existing bill.
Payment rates to doctors and other medical providers would be negotiated with the secretary of Health and Human Services, instead of tied to Medicare rates as the bill now says. The Blue Dogs contend that change will lead to fairer payment rates.
In addition to the public plan, states will have the option of setting up health care co-ops. Details on that were still being worked out.
Instead of the federal government picking up the full cost of an expansion of Medicaid, states would pick up part of the costs.
Ross said that together the changes would make the bill about $100 billion cheaper of the $1.5 trillion price tag, though the Congressional Budget Office had yet to weigh in with its analysis of the cost.