Final health care talks start

WASHINGTON — Democratic leaders in Congress began a final round of health care talks Tuesday, pledging to overcome their remaining differences, with the aim of sending a bill to President Obama before his State of the Union address in late January or early February.

The legislative overhaul of the nation's health care system stands closer to enactment than any similar effort in nearly 100 years. But before Democrats can claim victory, major policy gaps must be bridged.

Among them: The House's version of the bill would create a federally funded insurance option, while the Senate's would not; and the House would create a national insurance exchange, while the Senate would take a state-by-state approach to such a marketplace.

Congressional negotiators have little room to maneuver, given the narrow margins of support for the legislation in both chambers. Both conservative and liberal Democrats are wary that the bill would shift too much away from their positions.

The public insurance option remains a top priority for liberals, but before Christmas Senate Majority Leader Harry Reid, D-Nev., was unable to secure the 60 votes needed in that chamber to support such a plan.

Talking to reporters Tuesday, House Speaker Nancy Pelosi, D-Calif., suggested that a public option is not the only way to guarantee competition and affordable premiums. "There are other ways to do that, and we look forward to having those discussions as we reconcile the bill," she said.

Party leaders have not settled on a process for that reconciliation.

In a White House meeting Tuesday evening, Obama and Democratic leaders agreed on a fast-track alternative to the traditional House-Senate conference committee. The informal approach would still require the House and Senate to pass identical bills but would minimize the opportunity for Senate Republicans — who united in opposition to the legislation — to slow the process. Under the plan, the House would pass the Senate bill amended with new compromise provisions, then send the package back to the Senate for one final vote.

Republicans decried the idea as a breach of Obama's transparency pledge, while some House liberals objected to losing the public forum that a conference committee would provide. Even C-SPAN, the cable television network devoted to public affairs programming, complained about the possibility of a closed-door finale to a process destined to "affect the lives of every single American," as Brian Lamb, the network's chairman, wrote to House and Senate leaders on Dec. 30.

But Obama and Democratic leaders concluded that Republicans had left them with no other option, according to a senior Democratic aide who was briefed on the meeting. Democrats are eager to wrap up the health care debate to move on to two other pressing issues: job creation and deficit reduction.