With end in sight, unpredictable Massachusetts Senate race gives urgency to health care talks

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For health care, a frantic ride in the final days

WASHINGTON — Like a roller-coaster ride on its last twisting turns, President Barack Obama’s campaign to remake health care is barreling into final days of breathless suspense and headlong momentum.

Democrats, led by Obama himself, are deploying this weekend to salvage an unpredictable Senate race in Massachusetts, while senior White House and congressional staffers in Washington hurry to finish work on cost and coverage options at the heart of the sweeping legislation.

A Republican victory in the race to fill the late Sen. Edward M. Kennedy’s seat would deprive Democrats of the 60-vote majority needed to pass the bill in the Senate. Obama and Democratic congressional leaders would have a political window of perhaps days only to try to ram the bill through — at considerable risk of incurring public wrath.

Democrats put on a bold public face Friday, while working behind the scenes with grim determination.

Negotiators are “pretty close,” Senate Majority Leader Harry Reid said at the end of a week of marathon negotiations to reconcile House- and Senate-passed versions.

A White House statement said there are “no final agreements and no overall package.” But no further meetings were scheduled, and Rep. Jim Clyburn, D-S.C., the third-ranking House Democrat, said, “Something should be going to CBO very soon,” indicating that aides were drafting the decisions made around the table in the White House Cabinet Room. The Congressional Budget Office is the official arbiter of the cost and extent of coverage that any legislation would provide.

No details were immediately available, and congressional aides stressed the decisions made at the White House had not yet been fully shared with the Democratic rank and file.

One key obstacle appeared on its way to a resolution when Sen. Ben Nelson, D-Neb., requested the elimination of an intensely controversial, one-of-a-kind federal subsidy to cover the entire cost of a Medicaid expansion in his home state.

That provision in the Senate-passed measure has drawn criticism from governors and others in both political parties from the moment it was disclosed, and even former President Bill Clinton urged that it be jettisoned.

In its place, officials said Obama and lawmakers decided to increase federal money for Medicaid in all 50 states, although it was not clear if there would be enough to cover the expansion completely.

The increase in the Medicaid program is a key element in the bill’s overall goal of expanding health coverage to millions who lack it. The bill also envisions creation of new insurance exchanges, federally regulated marketplaces where consumers can shop for coverage. Individuals and families at lower incomes would receive federal subsidies to defray the cost.

The legislation would curb insurance industry practices such as denial of coverage because of medical problems and charging higher premiums to people in poor health.

At the White House, spokesman Robert Gibbs was unequivocal that Obama’s effort would prove successful. “As you heard the president say yesterday, we’re going to get health care done,” he said.

Not everyone was quite so certain, particularly given poll results from Massachusetts that showed Republican Scott Brown within reach of an upset over Democrat Martha Coakley in a three-way race.

“If Scott Brown wins, it’ll kill the health bill,” said Rep. Barney Frank, D-Mass, reflecting that the Republican would provide opponents of the health care bill a decisive 41st vote to uphold a filibuster and block passage in the Senate. Frank predicted Coakley would ultimately prevail and thus preserve the essential 60-vote Senate majority. Obama hurriedly scheduled a weekend campaign trip to the state.

Even so, Frank’s remark sent shudders through the ranks of Democrats.

The president called on Congress in his inaugural address a year ago to send him legislation that would remake the health care system, including expansion of coverage, new regulations on industry and unprecedented measures to slow the rise in health care costs generally.

Obama has made an unusual commitment in time and energy to the negotiations at the White House, essentially serving as a referee on key issues that the House and Senate leaders could not resolve.

Beyond that, he was willing to reopen issues where the two bills were identical. One example involved the patent protection that drugmakers would receive for their biotech drugs from generic competitors. The president wants to give generic makers quicker entry into the marketplace, and the pharmaceutical industry’s top lobbyist, former Rep. W.J. Tauzin, sent an e-mail threatening to oppose the legislation if that happened.

Even with an agreement on cost and coverage issues, Obama and congressional Democrats would have to resolve controversy over abortion, coverage of immigrants and other issues before sealing a final compromise.

Associated Press writers Charles Babington, Alan Fram and Erica Werner contributed to this report.