House Democratic leaders sought to regain momentum for their health care overhaul Monday after getting tripped up by internecine fighting.
But even as Speaker Nancy Pelosi (D-Calif.) sought to put a sunny face on the legislation, she confronted fresh concerns from another large bloc of Democrats worried about the public insurance plan at the heart of the bill.
And Democrats also were clamoring for cover from President Barack Obama before they are asked to vote for a big tax increase to pay for the restructuring of the health system.
New Democrats added their voice to the conservative Blue Dogs in a letter to leadership that slammed plans to use Medicare reimbursement rates as the basis for such a plan.
Any public option that reimburses providers based on Medicare will ultimately undermine the ability of patients to receive their choice of care, the letter states.
Blue Dog Rep. Mike Ross (D-Ark.) has called the issue of Medicare rates a deal-breaker for most Blue Dogs, arguing that regional disparities must be addressed first to ensure access to doctors, particularly in rural areas. But the liberal Progressive Caucus is demanding a Medicare-like public plan that is available to anyone.
Pelosi said the ongoing discussions were part of the legislative process and that the bill would continue to be refined.
She sought to deflect criticism by arguing the bill would lower costs and enhance coverage for the middle class, and she defended a proposed tax increase on the rich to pay for it.
Middle-income people are not touched by the tax increase, she said at a press conference that featured a coffee shop owner, an unemployed couple and a senior on Medicare who said they would benefit from the bill.
The Democratic bill would provide a host of benefits for middle-class people, including eliminating rules on pre-existing conditions and the fear that they would lose their insurance if they lose their jobs, Pelosi said.
This is about the middle class in our country, she said. Lower their costs, improve their quality, expand their coverage and do so in a way that gives them piece of mind. ... This is about them.
House Ways and Means Chairman Charlie Rangel (D-N.Y.) said last week that the tax increase would raise $540 billion over a decade and would affect families making more than $350,000 a year starting in 2011.
Meanwhile, Democrats are eager for cover on how to pay for the bill from Obama, who met late Monday with top House and Senate Democrats to discuss the health care overhaul.
Weve seen on other bills the presidents not been fully engaged, and hes really got to be engaged right now, said one top Democratic aide. We really need the president to weigh in or were going to keep getting pummeled by Republicans.
But the aide predicted that the tax hike should be broadly acceptable to the Democratic Caucus because it is similar to other tax hikes voted on during the previous Congress and mirrors the platform many Democrats campaigned on.
A White House aide stopped short of endorsing the House tax hike Monday but called it one of several good ideas on the table that would only affect the very wealthiest Americans.