The end game in sight, Senate Democrats coped with stubborn internal differences as well as implacable Republican opposition on Monday in a struggle to pass health care legislation by Christmas.A liberal-backed call to expand Medicare as part of the legislation drew strong opposition from Sen. Joe Lieberman, I-Conn. and quieter concerns from a dozen Democrats, raising significant doubts about its ability to survive.
Congressional officials said the administration was recommending the provision be jettisoned to clear the way for the most sweeping health care legislation in a half-century. In response, a top presidential aide, Dan Pfeiffer, said, "The White House is not pushing (Senate Majority Leader Harry) Reid in any direction, we are working hand in hand with the Senate leadership to work through the various issues and pass health reform as soon as possible."
Disputes over abortion and the importation of prescription drugs from Canada and other countries also flared.
Democrats are "looking for 60 votes," said Dick Durbin of Illinois, the party's second-ranking Senate leader -- a statement that has characterized their effort to overcome Republican opposition for months.
President Barack Obama, the fate of his top domestic priority in doubt, invited all Senate Democrats to a meeting at the White House complex on Tuesday -- possibly the final day for an agreement if the legislation is to clear the Senate before Christmas.
In the interim, the president's Monday schedule included a meeting with Sen. Bob Casey, D-Pa., who has been trying to negotiate a compromise on the abortion issue with Sen. Ben Nelson of Nebraska. Both senators oppose abortions, but Nelson has been outspoken in demanding changes in the bill before he can vote for it.
The overall measure, costing nearly $1 trillion over a decade, is designed to expand coverage and ban the insurance industry practice of denying coverage on the basis of pre-existing medical conditions. Obama has also urged Congress to slow the rate of growth in health care spending nationally, and several days after Reid submitted a package of revisions, lawmakers awaited final word from the Congressional Budget Office on that point.
Additionally, a top administration economic adviser acknowledged Monday that the Democratic-backed health care measure would raise spending in the short run, but she said it would eventually generate more than enough savings to offset the expense of expanded coverage.
"Our bottom line is that the bills as they are coming through will genuinely slow the growth of health care spending, both public and private, by about 1 percentage point a year for an extended period," said Christina Romer, chair of the Council of Economic Advisers.
Sen. Byron Dorgan, D-N.D., led the effort to lift a long-standing ban on the importation of prescription drugs from Canada and elsewhere. Obama favored the plan as a senator, but the pharmaceutical industry is opposed, and the White House appeared anxious not to jeopardize a months-long alliance with drug makers who have been helpful in trying to pass the overhaul.
But the obstacle that loomed largest was a proposal to permit uninsured men and women to purchase Medicare coverage as early as age 55.
It emerged last week as part of a framework agreement between moderates and liberals struggling to define the role of government in the newly revised health care system. Additionally, the proposal calls for creation of nationwide plans run by private insurance companies under the supervision of the Office of Personnel Management, the agency that oversees the system through which federal employees and lawmakers obtain their own coverage.