Health Care Talks End in Disarray

While the signs were more hopeful earlier in the day, fast-paced developments on Friday laid bare the growing tensions over health care legislation between liberal House Democratic leaders and fiscally conservative Democrats in the House Blue Dog Coalition.

One top Democrat threatened to bypass his own committee to speed passage of a bill, while another said that, after weeks of negotiations, discussions “pretty much fell apart this afternoon.” Read more about the day’s events here.

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Fred Prouser/Reuters Representative Henry Waxman of California

The chairman of the House Energy and Commerce Committee, Representative Henry Waxman of California, said Friday that House leaders had reached a potentially crucial agreement on reducing geographical disparities in the rates that Medicare pays health-care providers around the country.

A faction of seven centrist Democrats who are members of the fiscally conservative Blue Dog Coalition have stalled work on the Democrats’ big health care legislation over concerns about the cost and scope of the bill. One of their concerns is the disparity in Medicare payments, with lower amounts paid in rural areas.

Mr. Waxman said House leaders had met late into the night Thursday in an effort to resolve that particular concern, and he said he would be meeting shortly with the seven Blue Dogs to discuss the proposal. But he also threatened to push ahead if the Blue Dogs remained unwilling to compromise.

“I think the Blue Dogs raised a number of important issues,” Mr. Waxman said in an interview just outside the House chamber. “But this cannot be an interminable discussion.”

If the Blue Dogs insist on blocking work in the Energy and Commerce Committee, Mr. Waxman said, he is prepared to let House leaders take procedural steps to bypass his committee. Two other panels, the Education and Labor Committee and the tax-writing Ways and Means Committee, have already approved the health care legislation. Only the Energy and Commerce Committee needs to act before the measure can be taken up on the House floor.

Mr. Waxman called the proposal on reducing the geographic disparities “a significant breakthrough,” and he noted that it would change payments to providers not only through Medicare, the government insurance program for people over the age of 65, but also under a new government-run insurance plan that Democrats have proposed to compete with private insurers. Under the House bill, provider rates would initially be tied to Medicare rates, plus 5 percent.

The seven Blue Dogs are a potentially decisive bloc on the energy and commerce panel, which comprises 36 Democrats and 23 Republicans. Mr. Waxman said he would rather let House leaders bypass the committee than allow Blue Dogs to cede control to the Republicans.

“I won’t allow them to turn over control of the committee to Republicans, which they have threatened to do,” he said, adding, “I hope they’ll agree to let our committee go forward with the mark up and not vote with the Republicans to eviscerate this legislation.”

Many House Democrats are also anxiously awaiting word from the Senate Finance Committee over how that panel will propose to pay for the health care bill. House leaders have proposed a surtax on high-income Americans to generate $544 billion toward the roughly $1 trillion, 10-year cost of the bill. But rank-and-file House members are reluctant to vote for that tax increase without knowing that the Senate plans to endorse it. Senators have expressed little interest in the idea.

The Senate majority leader, Harry Reid of Nevada, and the Finance Committee chairman, Senator Max Baucus of Montana, went to the White House on Friday morning to meet with President Obama about the developing health care legislation. See related article.