Senate Finance Committee negotiators are trying to bring down the cost of a broad health-care bill, but new splits are emerging on whether to reduce subsidies for people to buy insurance, according to Senate aides familiar with the talks.
The Finance Committee, led by three Democrats and three Republicans who make up the so-called Gang of Six negotiators, is the only committee in Congress seeking to produce a bipartisan bill.
Republicans are pressing to reduce the size of tax credits for families with incomes that are below three times the poverty rate. They would also like to trim back insurance coverage mandates in hopes of lowering premiums that would have to be subsidized.
But the three Democrats believe savings can be found without going to the heart of the bill. "There are not going to be significant changes to coverage," said one Democratic aide familiar with the talks. "We're finding other ways to bring down the cost."
The six negotiators are working against a Sept. 15 deadline to reach a deal before Democratic leaders give up and move ahead with a partisan bill. A conference call went until nearly midnight Thursday with no major breakthroughs.
Both sides say the core of a bill has already come together that would represent dramatic changes, both for those with health insurance and the uninsured. That core bill would impose new regulations on insurance companies, preventing them from withholding coverage for applicants with pre-existing conditions or dropping coverage when a customer gets sick. It would also cap out-of-pocket expenses and end lifetime coverage caps. And insurers would have to narrow price differences for comparable policies.
In exchange, the insurers would get a huge new customer base: most of the 46 million uninsured, who would be mandated to purchase insurance through a new, federally created exchange. Families up to three times the poverty rate would get generous tax credits for those purchases. Medicaid, the federal-state health plan for the poor, would be expanded to 133% of the poverty level.
To hold down health inflation, health-care providers such as doctors and hospitals would be encouraged to coordinate care. Negotiators are looking at several ways to do that, perhaps by paying higher reimbursements to providers in coordinated-care clinics or by sending out lump-sum payments for a given patient's care. That way, all providers involved in a case -- from the emergency-room doctor who admitted a broken-hip patient, to the orthopedist and the physical therapist who treated the patient -- would have to work together to divide up payments.
Under the Finance plan, wellness programs would also be targeted at the populations most in need, such as diabetics, smokers or the obese. The senators have already said their bill won't include a Medicare-like public-insurance plan to compete with private insurers, and they are now weighing whether to omit as well an alternative idea for nonprofit health-insurance cooperatives.
Ron Pollack, executive director of Families USA, a liberal health-care group, said it was important that controversial elements of the health-care bill "do not obscure" the broad agreements reached on key issues. "The American public does not yet fully understand all these other elements that are close to consensus," Mr. Pollack said.
But aides involved in the negotiations say the controversies are taking a toll. Liberals are ratcheting up pressure on Democrats to demand a public option in any health-care overhaul. Liberal bloggers, in 72 hours, raised $309,393 from 5,155 donors for congressmen demanding a government insurance option. Jane Hamsher, one of the bloggers organizing the campaign, said Friday the left will never accept an individual mandate to purchase insurance if the insurance must come from private insurers.
The three Senate Republicans on the Gang of Six -- Charles Grassley of Iowa, Mike Enzi of Wyoming and Olympia Snowe of Maine -- won't sign off on a deal without a public option if they think Democrats would later bow to pressure and insert one, one Republican aide said.
The Senate Finance negotiators are still far away from agreeing on how to pay for the subsidies to people for buying insurance. Finance negotiators are counting on raising $180 billion by taxing high-cost insurance plans, but Democrats are under pressure to whittle that down or drop it altogether.