Senate healthcare bill may be hard to reconcile with House’s

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As the Senate lumbers toward passage of its healthcare bill, Democrats are looking ahead to the potentially difficult process of reconciling its substantial differences with the more liberal House version -- the last major obstacle before President Obama can sign landmark legislation into law.

The final Senate vote on the healthcare bill was set for 8 a.m. Thursday, Christmas Eve, as Republicans held the floor Tuesday to criticize the measure and delay its enactment. Democrats are hopeful that the momentum generated by the long-awaited Senate vote -- and the high political stakes involved in finishing the job -- will grease the wheels of negotiations with the House.

“Each side knows we cannot fail,” said Sen. Charles E. Schumer (D-N.Y.). “Each side knows they have to give.”

But after lawmakers enjoy what is left of the holiday season in their home states, they will return to wide and deeply held differences between the House and Senate bills on federal funding for abortion and the liberals’ dream of establishing a “public option” -- a government plan that would compete with private insurers -- to guarantee access to affordable insurance.

Negotiators also will have to hammer out disagreements that will determine how quickly the bill takes effect, what taxes will be raised, and other items that reach deeply into every hospital, doctor’s office and home medicine cabinet.

Nancy-Ann DeParle, Obama’s health advisor, acknowledged that many liberal House Democrats feel they already have compromised too much on the public option. But, she added, she was encouraged by signs that they do not see the matter as nonnegotiable.

Moreover, DeParle said as she shuttled between meetings in the Capitol on Tuesday, some of the conservative Democrats who voted against the House bill have told her that they might be open to the final version of the legislation if it included more cost-containment provisions, as the Senate bill does.

In a gesture to underscore his commitment to seeing the fight through, Obama said Tuesday that he would delay his planned Christmas trip to Hawaii -- which was scheduled to start today -- until after the bill passed.

“If they’re making these sacrifices to provide healthcare to all Americans, then the least I can do is to be around and to provide them any encouragement and last-minute help if necessary,” Obama told reporters.

The outcome of Senate debate has been a settled matter since early Monday morning, when the chamber took the first of a series of procedural votes after Majority Leader Harry Reid (D-Nev.) crafted a compromise that garnered support from all 60 members of the Democratic caucus.

On Tuesday, the Senate voted 60 to 39 to clear the next procedural hurdle. (GOP Sen. James M. Inhofe of Oklahoma was absent from the party-line roll call.) After another procedural vote today, the bill will come up for final passage at an unusually early hour Thursday to give senators time to get home for Christmas.

“The finish line is in sight,” finance committee Chairman Max Baucus (D-Mont.) said at a news conference. “We’re not the first to attempt such reforms, but we will be the first to succeed.”

Senate debate stretched into its 23rd day Tuesday as Republicans continued to demand time to highlight their opposition to a bill that they see as a costly, dangerous expansion of government power. And they delighted in turning a spotlight on the backroom deals that went into building Democratic support.

Among the agreements was a federal government commitment to pick up the full cost of expanding Medicaid in Nebraska to cover all people making less than 133% of the federal poverty level. Other states must split the cost of the expansion with Washington.

The Nebraska exception was made to win the vote of that state’s Sen. Ben Nelson, who on Saturday became the last Democrat to line up behind the bill. Another Medicaid exception was made for Louisiana some time ago as an enticement to Sen. Mary L. Landrieu (D-La.). Vermont and Massachusetts also get special treatment.

“This bill is a mess, and so was the process that was used to get it over the finish line,” said Senate Minority Leader Mitch McConnell (R-Ky.). “Americans are outraged by the last-minute, closed-door, sweetheart deals that were made to gain the slimmest margin for passage.”

As Democrats began to contemplate what compromises will be needed between the House and Senate, Obama responded to criticism -- mostly from liberals -- that he had given away too much in order to get a bill passed.

“Nowhere has there been a bigger gap between the perceptions of compromise and the realities of compromise than in the healthcare bill,” Obama said in an interview with the Washington Post. “Every single criteria for reform I put forward is in this bill.”

Liberals’ central bone of contention is that Obama did not push harder for the public option. But even in the more liberal House, it was impossible to pass the public option without watering down the government’s role in setting reimbursement rates.

For some time, Speaker Nancy Pelosi (D-San Francisco) has said that the House could not pass a bill without a public option. And some liberals have threatened to vote against the entire bill if the provision is dropped.

Rep. Raul M. Grijalva (D-Ariz.), co-chairman of the Congressional Progressive Caucus, criticized the Senate and the White House, saying: “We need strong leadership so close to the finish line, not efforts to water down a bill to the breaking point.”

It may be even harder to resolve differences between the House and Senate provisions on abortion. Leading opponents of abortion favor the House’s stricter language banning federal funding for the procedure. A key question is whether the House’s sizable faction of antiabortion Democrats will vote against the bill if the provisions are not to their liking.

Noam N. Levey in the Washington bureau contributed to this report.