Obama calls for action on healthcare

Reporting from Washington — 

An impassioned President Obama on Wednesday challenged Congress to vote on sweeping healthcare legislation “in the next few weeks,” even if doing so means having to maneuver around the Republican minority.

“I believe the United States Congress owes the American people a final vote on healthcare reform,” Obama said Wednesday from the East Room of the White House. “We have debated this issue thoroughly, not just for the past year, but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of 60 votes.

“Now is the time to make a decision,” he said.

It was the strongest, most specific language the president has used to drive his healthcare plans forward. And he set a clear timeline for wrapping up the drama that has now run for more than a year.

After the speech, the White House indicated that the president would take to the road next week to campaign for the legislation with stops in Philadelphia and St. Louis.

And on Capitol Hill, Democratic leaders were making the final push to line up the necessary votes behind a two-part strategy that will rely on a parliamentary maneuver known as budget reconciliation to prevent a Republican filibuster in the Senate from blocking the legislation.

Under that strategy, House Democrats would approve and send to the president the health bill passed by the Senate last year. Both the House and Senate would then approve a second bill containing changes to the terms of the Senate bill, using budget reconciliation.

Under Senate rules, bills voted on under that process can pass with a simple 51-vote majority, rather than the 60-vote supermajority needed to stop filibusters. There are 59 members in the Senate’s Democratic caucus, including two independents.

Obama made it clear Wednesday that he would back reconciliation to advance healthcare, citing its use by the GOP to overhaul welfare in the 1990s and to pass two large tax cuts in the last Bush administration.

Healthcare “deserves the same kind of up-or-down vote,” Obama said.

It doesn’t promise to be easy.

Senior Democrats on Capitol Hill will not finish writing the reconciliation package until next week at the earliest, according to senior congressional aides.

For the strategy to work, the package will have to address a host of concerns that House Democrats have with the Senate bill. Party leaders have largely agreed to scale back a new tax on high-end “Cadillac” health plans, to gradually close the coverage gap in Medicare’s Part D drug benefit, and to boost assistance to low- and moderate-income Americans who will be required to buy insurance.

But because budget reconciliation is restricted to spending and taxation measures, the package will not address concerns that some House Democrats have with provisions in the Senate bill dealing with abortion and prohibiting many undocumented immigrants from buying insurance.

That threatens to complicate House Speaker Nancy Pelosi’s hunt for the 216 votes needed to approve the Senate bill and the reconciliation package. Democrats have a large majority in the House, but not all have committed to voting for the legislation.

Pelosi (D-San Francisco) and other senior Democrats have suggested that abortion and immigration could be dealt with in future legislation. But for now, House leaders are trying to convince their members to look past individual problems they have with the bill.

That still may not be enough for some conservative Democrats, whose constituents are vehemently opposed to it.

“It’s a no-win situation for those of us in moderate districts,” said one House Democrat who asked not to be named when describing his quandary. “If you vote no, your base is upset. If you vote yes, everyone else is upset. You almost couldn’t design a legislative vise more damaging to moderate Democrats -- or that puts our majority more at risk.”

GOP leaders are already stepping up accusations that Democrats are arrogantly ignoring the public, a charge repeated by Senate Minority Leader Mitch McConnell on Wednesday after the president spoke.

“They think they are smarter than the American people,” he said. “They think, ‘We’re going to give this to you, whether you want it or not.’ ” McConnell predicted that if Democrats enact their overhaul, “there is an overwhelming likelihood that every Republican candidate will be campaigning to repeal it.”

In the Senate, Democrats face another challenge from Republicans if they try to bring the reconciliation package to the floor.

The Senate’s rules limit debate on the measure to 20 hours, but there is no limit on the number of amendments that Republicans can offer, raising the spectacle of what has come to be known as a “vote-a-rama” that could drag on for days.

A senior GOP advisor conceded that senators may not have the stamina to keep it up, but they may still cause trouble by forcing roll calls on politically sensitive amendments, some of which may have nothing to do with healthcare.

At the White House on Wednesday, Obama made one more nod to his opponents, highlighting Republican ideas that Democrats have incorporated into their health legislation.

And he repeated an offer he made Tuesday to use additional Republican proposals, including initiatives to root out Medicare fraud, reduce medical malpractice lawsuits and encourage greater use of individual health savings accounts.

My plan “incorporates the best ideas from Democrats and Republicans -- including some of the ideas that Republicans offered during the healthcare summit,” Obama said.

But the president made it clear that he would settle for nothing less than legislation that would expand coverage and tighten regulation of the insurance industry.

He rejected GOP calls to start anew. “The insurance companies aren’t starting over. They’re continuing to raise premiums and deny coverage as we speak,” he said. “For us to start over now could simply lead to delay that could last for another decade, or even more.” And Obama explicitly invited Republicans to reject the legislation if they disagreed with Democratic moves to strengthen government.

“If they truly believe that less regulation would lead to higher-quality, more-affordable health insurance, then they should vote against the proposal I’ve put forward,” he said.

n oam.levey@latimes.com

j anet.hook@latimes.com