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House Heads for Showdown

But while some moderates push behind the scenes for more austerity, few want to hold press conferences calling for cuts in Medicare, taxing insurance or less generous benefits. And while Blue Dogs have frequently urged more cost-cutting, they have not coalesced around a particular plan to do so. As liberals have noted, many in the group are rallying for a version of the public insurance option that would cost $85 billion more than the one liberal Members are pushing.

Pelosi is feeling the heat from a broad swath of her Caucus to stick to the original House bill with just a tweak or two. Some 157 Members signed onto a letter urging Pelosi not to change the bill to tax insurance plans, although they stopped short of threatening to vote against the bill.

Sophomore Rep. Joe Courtney (D-Conn.) led the letter-writing campaign, saying Wednesday that Democrats promised not to heap more taxes on the middle class and to reject taxes on health insurance during the campaign.

“We are sending the message to the other chamber and to the White House,” he said. “We are sending a big warning flag. ... There is overwhelming opposition in the House.”

And a liberal bloc has frequently threatened to bring down the bill if a public insurance option is not included and based on Medicare rates, although moderates doubt whether they will actually vote against the bill.

A few changes that are being considered to get the CBO score down include increasing eligibility for Medicaid, which actually cuts costs because it is a public insurance option that pays low rates to providers.

Members are also looking at a compromise on the public option that would start it using negotiated rates and trigger Medicare rates if costs rise quickly. Another proposal would peg reimbursement rates for a public insurance plan 10 percent or 15 percent below private insurers rather than basing them on Medicare.

But some moderates say that while the short-term costs may come down, the CBO is still likely to slam the plan as failing to contain the deficit beyond the first 10 years.

Whether that’s really much of a political problem is open to debate. When Democrats pushed through a bill preventing a premium increase for wealthy seniors under Medicare recently, just five voted no.

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