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Democrats Struggle to Finish Health Bill

WASHINGTON — House and Senate Democratic leaders struggled Thursday to stitch together pieces of a final health care bill as rank-and-file Democrats demanded more information about the contents of the bill and its cost.

Leaving a meeting of the House Democratic Caucus, lawmakers said they had received few details about what would be in the legislation, on which they may be asked to vote in the next week or two.

“Everyone expressed frustration that we do not have comprehensive cost estimates from the Congressional Budget Office,” said Representative Gerald E. Connolly, Democrat of Virginia.

In addition, lawmakers said, they were not given the text of the latest legislation drafted by House and Senate Democratic leaders and the White House to address widespread concerns about the bill passed by the Senate in December.

Speaker Nancy Pelosi said the House would soon approve the Senate bill and a separate package of changes, using a procedure known as budget reconciliation to avoid the threat of a filibuster against the second bill in the Senate.

Representative Anthony D. Weiner, Democrat of New York, said it was difficult for lawmakers to know how they would vote on a bill they had not seen.

House Democrats said Ms. Pelosi had assured them they would have at least one week to examine the text of the budget bill before voting on it.

Democratic aides said House leaders wanted the vote to occur before a two-week spring break scheduled to start on March 26. Otherwise, they said, wavering lawmakers might buckle to pressure from critics of the bill, who plan to step up their campaign against it during the recess.

President Obama plans to leave Thursday on a trip to Indonesia and Australia. With his health care bill hanging in the balance, he faces intensifying questions about whether he should put off the trip, which was timed to coincide with his daughters’ spring break.

The budget reconciliation bill would reduce the Senate’s tax on high-cost health insurance plans and increase subsidies to help low-income people buy health insurance, Ms. Pelosi said. To help offset the additional costs, lawmakers would increase the Medicare payroll tax on wages and extend it to unearned income, like dividends and interest, for affluent taxpayers.

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Speaker Nancy Pelosi spoke to reporters Thursday after a House Democratic caucus meeting. Credit...Chip Somodevilla/Getty Images

Democratic leaders in the two chambers said Thursday that they had reached agreement to use the budget bill as a vehicle to enact another of Mr. Obama’s top domestic priorities, overhauling the student loan program. Under the president’s plan, the government would make loans directly to students, instead of guaranteeing loans by private banks.

But Democrats said they were nowhere near agreement on the explosive question of how to restrict insurance coverage of abortion under the health care bill.

Democratic opponents of abortion, led by Representative Bart Stupak of Michigan, have threatened to vote against the Senate bill, saying its abortion restrictions are not tough enough. Senate rules and precedents suggest that the budget bill could not be used to alter those restrictions because they would not have a substantial effect on federal spending.

House Democratic leaders have had desultory talks with Mr. Stupak, but appeared willing to bypass him if they conclude his vote is not needed. Mr. Stupak said he and at least 11 other House Democrats would vote against the Senate bill unless the abortion language was changed.

But Representative Jan Schakowsky, Democrat of Illinois, said she doubted that Mr. Stupak had as may votes as he claimed.

“There is no way in this legislation to satisfy Bart’s demands,” Ms. Schakowsky said. Mr. Stupak wants to bar the use of federal money to pay for any part of the costs of any health plan that includes coverage of elective abortions.

In both chambers, Democrats are preparing for a titanic battle that will involve politics and parliamentary procedure as much as health policy.

House Democrats are so skittish about the Senate bill that they are considering a maneuver that would allow them to pass it without explicitly voting for it. The Senate measure would be “deemed passed” if and when the House adopts rules for debate on the follow-up budget reconciliation bill. If the House approves both bills, the health care measure would be ready for signing by the president. But the budget bill would go to the Senate, where Republicans plan to propose dozens of amendments.

Senator Richard J. Durbin of Illinois, the No. 2 Democrat in the Senate, said it might eventually be necessary for the presiding officer — perhaps Vice President Joseph R. Biden Jr. — to limit the number of amendments.

Mr. Durbin said “there is no precedent” that would prevent the presiding officer from taking such action. At some point, Mr. Durbin said, the Senate must decide: “What is dilatory? How many amendments are too many?”

In an updated report, the Congressional Budget Office said Thursday that the Senate-passed bill would spend $875 billion to provide coverage for 31 million uninsured people over the next 10 years. The cost, it said, would be more than offset by new taxes and fees and by cutbacks in Medicare, so the bill would reduce budget deficits by a total of $118 billion over 10 years.

Moreover, the budget office said, in the decade after 2019, the bill would tend to reduce the “federal budgetary commitment to health care,” which reflects the cost of health programs and tax breaks for health care.

David M. Herszenhorn and Sheryl Gay Stolberg contributed reporting.

A version of this article appears in print on  , Section A, Page 17 of the New York edition with the headline: Democrats Struggle To Finish Health Bill. Order Reprints | Today’s Paper | Subscribe

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