Key House Democrats agreed Friday on steps designed to cut the growth of Medicare, clearing one of numerous obstacles blocking an early vote on health care legislation.
But even as Speaker Nancy Pelosi hailed the agreement as a "giant step forward" on President Barack Obama's top domestic legislation, leaders struggled without success to ease the concerns of moderate to conservative Democrats who have held up progress on the bill for a week. With the talks at a deadlock, a key committee chairman suggested an end run around the rebels.
At the White House, Obama met with senators in an attempt to speed completion of a bipartisan deal that has been under discussion for weeks.
The flurry of activity occurred as the administration and Democratic leaders fought back against the impression that the legislation was sputtering despite months of effort and negotiation.
Democratic officials in the House said late-night talks had produced agreement on changes in Medicare to try and reward doctors, hospitals and other providers for high-quality care. Critics argue the current system simply pays by volume - compensating providers regardless of whether additional medical procedures contribute to better health care.
Under the agreement, the Institute of Medicine would complete a study by September 2011 recommending changes in the current fee structure. The administration would have 45 days to submit the report to Congress, and it would go into effect unless Congress blocked it by the end of February 2012.
Separately, lawmakers agreed to call for a second study by the Institute of Medicine to investigate regional differences in payments to Medicare providers, to be implemented in 2014.
Officials said the two steps combined were designed to control the steady increase in Medicare costs, although they provided no immediate estimates of anticipated savings.
Obama has said repeatedly he wants legislation to control the cost of health care as well as to expand insurance coverage to millions who now lack it.
In another part of the Capitol on Friday, Rep. Mike Ross, D-Ark., said attempts by so-called Blue Dogs to win changes had ended in stalemate.
"It pretty much fell apart this afternoon," he said.
The group has enough votes on the Energy and Commerce Committee to prevent the bill's passage there, and the chairman, Rep. Henry Waxman, D-Calif., raised the possibility of simply bypassing the panel and taking the legislation directly to the floor.
"We're going to have to look at perhaps bypassing the committee because we've got to get moving on this legislation," he said. "I hope we don't come to that conclusion."
He said that while negotiations with Democratic critics are continuing, "we're not going to let them empower the Republicans to control the committee." No House Republican has yet expressed support for the health bill that the White House is seeking.
As lawmakers continued to haggle, the White House said Obama will keep working on health care in August even if Congress goes home.
"Nobody in planning meetings decided we should just take August off," said White House press secretary Robert Gibbs. "For a long time we planned to continue the discussion of the issues that are important, be it the economy, health care ... education. That had always in many ways been priced into the scenario."
Obama envisions legislation that would, for the first time, require all Americans to be insured. A new government insurance program would compete with private insurers, and insurance companies would be barred from excluding people with pre-existing conditions. The goals are to hold down costs and extend coverage to most of the 50 million uninsured. The price tag: $1 trillion-plus over a decade.
Obama met Friday morning at the White House with Senate Majority Leader Harry Reid, D-Nev., and Finance Committee Chairman Max Baucus, D-Mont. Reid said Thursday that the panel will push to complete a bill before the Senate breaks Aug. 7. Baucus has been negotiating with the panel's Republicans in hopes of producing a bipartisan bill.
This program aired on July 24, 2009. The audio for this program is not available.