President Barack Obama is prodding House and Senate Democrats to get him a final health care bill as soon as possible, encouraging them to bypass the usual negotiations between the two chambers in the interest of speed.
Obama delivered the message at an Oval Office meeting Tuesday evening with House Speaker Nancy Pelosi and House Majority Leader Steny Hoyer. Senate Majority Leader Harry Reid and his No. 2, Sen. Dick Durbin, D-Ill., joined in by phone.
They agreed that rather than setting up a formal conference committee to resolve differences between health bills passed last year by the House and Senate, the House will work off the Senate's version, amend it and send it back to the Senate for final passage, according to a House leadership aide, speaking on condition of anonymity in order to discuss the private meeting.
Obama himself will take a hands-on role, convening another meeting with congressional leaders at the White House on Wednesday, the aide said.
The aim is to get a final bill to Obama's desk before the State of the Union address sometime in early February.
Facing the need to maintain a tenuous 60-vote coalition in the Senate, House Democrats will probably have to give up on starting a new government insurance plan to compete with the private market, something that's a nonstarter with Senate moderates. In its place they hope for more generous subsidies for lower-income families to buy health insurance.
Obama agreed at Tuesday evening's meeting to help strengthen affordability measures beyond what's in the Senate bill, the aide said.
Pelosi suggested Tuesday that House members wouldn't insist on the government plan as long as the final bill provides "affordability for the middle class, accountability for the insurance companies, ... accessibility by lowering cost at every stage."
"There are other ways to do that, and we look forward to having those discussions," she said.
House Democrats want the Senate to agree to language revoking insurers' antitrust exemption as a way to hold insurance companies accountable in absence of direct government competition, said Rep. Chris Van Hollen, D-Md., a member of the House leadership.
The bills passed by the House and Senate both would require nearly all Americans to get coverage and would provide subsidies for many who can't afford the cost, but they differ on hundreds of details. Among them are whom to tax, how many people to cover, how to restrict taxpayer funding for abortion and whether illegal immigrants should be allowed to buy coverage in the new markets with their own money.
Concerns about affordability are paramount. Major subsidies under the bills wouldn't start flowing to consumers until 2013 at the earliest. Even with federal aid, many families still would face substantial costs.
The House bill would provide $602 billion in subsidies from 2013-2019, covering an additional 36 million people.
The Senate bill would start the aid a year later, providing $436 billion in subsidies from 2014-2019, and reducing the number of uninsured by 31 million.
"Affordability is a critical issue," Van Hollen said.
But sweetening the deal for low- and middle-income households could require more taxes to pay for additional subsidies. And the House and Senate are also at odds over whom to tax. The House wants to raise income taxes on individuals making more than $500,000 and couples over $1 million. The Senate would slap a new tax on high-cost insurance plans. Although the Obama administration supports the Senate's insurance tax as a cost-saver, labor unions, which contribute heavily to Democratic candidates, are against it.
The House may end up accepting the insurance tax if it hits fewer people than the Senate's design now calls for. There also could be common ground in a Senate proposal to raise Medicare payroll taxes on individuals making more than $200,000 and married couples over $250,000.
Democrats reacted defensively to criticism that they are taking the final, most crucial stage of the debate behind closed doors, contending they've conducted a transparent process with hundreds of public meetings and legislation posted online. Republicans seized on a newly released letter from the head of the C-SPAN network calling on congressional leaders to open the final talks to the public, and cited Obama's campaign trail pledge to do just that.
Asked about that promise, Pelosi remarked, without elaboration, "There are a number of things he was for on the campaign trail."
Associated Press writers Donna Cassata and Ricardo Alonso-Zaldivar contributed to this report.