Health Care Inches Ahead in the House

5209744At the House Democratic Caucus meeting this morning, members actually kicked staffers out of the meeting so they could delve into the nitty-gritty proposals of their evolving health care bill.

But for all that drama, House Speaker Nancy Pelosi and Majority Leader Steny Hoyer had little new to tell reporters after the meeting. Pelosi said they're not in the home stretch yet, but that "we are coming around the bend and we have to make our decision about what form the public option will be in the bill."

Hoyer said "we expect in the coming weeks to put a bill on the floor that will garner a majority of support of the Congress of the House of Representatives and pass that bill."

But the big challenge, as Pelosi pointed out this morning, is that the bill has to add up to zero. That means it cannot add anything to the deficit. Lawmakers are grappling with the scale right now as they take one provision off, put another on, tweak it here or there, and hope it comes out even.

Rep. Gerry Connolly (D-Va.), for instance, said that a surcharge on wealthier Americans is still the favored way to pay for the bill among House Democrats. However, he said traction is gaining to raise the income level.

Originally proposed to hit families who make over $350,000 per year, House Democrats now want to raise that to $1 million, but lawmakers have to grapple with how they make up for that lost revenue. Special Report: Health Care

Another idea, that is part of the Senate Finance proposal, is to tax "Cadillac" insurance programs. But Connolly said that idea has "really gained opposition," as labor unions have stepped up their opposition to that proposal. He said one other revenue raising possibilities is increasing the penalty on employers who do not offer health insurance from 8 to 9 percent.

And then there is the public option. The debate over tying public option payments to Medicare rates plus 5 percent versus allowing the government to negotiate rates is still going. Proponents of tying it to Medicare rates point to the increased savings which is around $85 billion. But opponents say that does nothing to fix regional disparities in how doctors are reimbursed when they treat patients on Medicare.

One Pelosi spokesman said those are the two options, but that there might be some answer somewhere in between and other ideas are being discussed.

Of course, some kind of compromise where lawmakers tie rates to Medicare AND fix regional disparities would still mean having to find savings somewhere else.

As members of Democratic leadership try to make the pieces of the puzzle fit, the details can get very cloudy. But it's clear that over the next few weeks there will be many more closed-door meetings in Pelosi's office with opposing caucuses like the Blue Dogs and progressives. There will be many more full Democratic Caucus meetings where leadership tries to get members to reach some kind of consensus. And there will be many more press conferences celebrating every inch of progress before a final product is actually brought to House the floor.

Health Care Reform Progress Report

Jill Jackson is a CBS News Capitol Hill Producer. You can read more of her posts in Hotsheet here. You can also follow her on Twitter.
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    Jill Jackson is a CBS News senior political producer.