Democrats are struggling to push through Barack Obama's proposal to overhaul the healthcare system before his August deadline, with committees working through the night to reach agreements on the issue. The healthcare reform, one of the pillars of Mr Obama's election campaign, aims to grant all citizens access to healthcare services. Currently, nearly 50 million Americans do not have health insurance.
After a 16-hour debate, the House of Representatives' Ways and Means Committee yesterday approved its section of the bill, including a tax increase on the most wealthy to help pay for it. Hours later, the House Education and Labor Committee followed suit, sending its portion of the bill to be debated on the House floor. So far three congressional committees have approved the legislation. But the proposal is controversial and complex, and the fact that the US president has challenged legislators to bring the bill to vote in both houses before the August summer recess is adding pressure. Though Mr Obama had hoped the bill would receive bipartisan backing, so far it has been pushed through with little Republican support, with committees voting along party lines.
In addition, several Democrats have joined Republicans to vote against the bill. Two committees still need to pass bills, including the Senate Finance Committee, where discussions have been difficult. With the country in the middle of the worst recession in 50 years and public debt at record levels, the financing of the plan, which is estimated to cost more than US$1 trillion (Dh3.67 trillion) over the next 10 years, has become a leading issue.
The Senate Finance Committee announced on Thursday that it had failed to reach an agreement and would resume discussions next week. Senator Max Baucus, chairman of the committee, has said Mr Obama's opposition to a controversial tax on employer-provided healthcare benefits, which Mr Baucus sees as a way to control spending, is "not helping" matters. Supporters of the bill suffered another setback on Thursday when the Congressional Budget Office said the proposal would not cut spending as promised, giving ammunition to fiscal conservatives, including a growing number of Democrats who are pushing for a new plan.
The healthcare reform has a dual aim of bringing healthcare coverage to the 46 million Americans who lack it - almost 15 per cent of the population - while simultaneously slowing the rate of growth of federal spending. However, Douglas Elmendorf, director of the CBO, a non-partisan agency and the official arbiter of the cost of the bill, told the Senate Budget Committee that the plan does not include the "fundamental changes" that would be necessary to reduce federal health spending, adding that rising healthcare costs would actually accelerate under the plan.
Olympia Snowe, a Democratic senator, has urged Mr Obama to give up his August deadline so the Finance Committee can draft a reform plan to control costs. "It's important for us to take time to work through these issues," she said after meeting with the president on Thursday. "We have a very complex, costly endeavour. So it is important that we get this right." Republicans also jumped on Mr Elmendorf's remarks, with the Senate's Republican leader, Mitch McConnell, saying that they should serve as "a wake-up call".
Amitabh Chandra, a public policy professor at Harvard University, was optimistic that some kind of healthcare reform by the Obama administration would eventually be passed, although he believed the bill's details would not emerge until at least September as legislators horse-traded their priorities. "There are two open questions. One is about the 47 million uninsured and they won't be able to expand coverage to all of them, so will it be expanded to 10m people, 20m, or 40m? The other question is if you expand coverage, then how will you pay for it and control costs?" he said. "There are so many uninsured people because of high cost growth and it's very hard to do anything about cost growth because you're talking about health providers' incomes."
Mr Obama and the Democrats are opposed to the taxation of employer-provided health insurance but Mr Chandra said such opposition was irrational because this created a regressive system that rewarded higher-paid employees as well as ignoring a potential source of billions of dollars in revenue. "We definitely need payment reform, looking at the whole way we reimburse health providers, but in the absence of that conversation, the chances are we'll need more reform in a few years time."
The overhaul would represent the biggest expansion of health care since Medicare and Medicaid were established in 1965. At its heart it requires insurance companies to offer policies to all, excluding them from being able to charge higher premiums for "pre-existing conditions". It proposes a health insurance exchange, which will allow families and small businesses to choose a private plan, or a public health insurance option and aims to cover 97 per cent of Americans by 2015.
Democrats have continued to try to drum up support for healthcare reform at the grassroots level by highlighting the plight of the millions who cannot afford health care. While the US spends more than most developed countries on health care, according to the Institute of Medicine, it is the only wealthy, industrialised national that does not provide some kind of universal healthcare support for its citizens.
The millions that lack healthcare provision, either because they do not qualify for government provided services, cannot afford it, do not qualify for private health insurance, struggle to get coverage for "pre-existing conditions" or are not provided with insurance by their employer, are sometimes forced to go without treatment. A television advertising campaign was launched by Organizing for America, a branch of the National Democratic Committee, last week. The 30-second slots, which will run for the next two weeks, show people discussing the hardships they face under the current system, and end with the message "It's time for health care reform".
The group has also enlisted volunteers to go door-to-door across the country to explain the White House's healthcare priorities. firstname.lastname@example.org * Foreign Correspondent Sharmila Devi contributed to this report from New York