WASHINGTON — — President Barack Obama and congressional Democrats are considering scaling back their health care overhaul in the wake of a Republican victory in the Massachusetts Senate race, hoping to salvage key elements of the package.
Now without a filibuster-proof majority in the Senate, some Democrats believe they could win Republican support for more limited changes to the health care system, including restrictions on insurance companies and new initiatives to restrain costs.
Obama appeared to endorse such an approach Wednesday. "I would advise that we try to move quickly to coalesce around those elements in the package that people agree on," the president said in an interview with ABC News.
"We know that we need insurance reform. The health insurance companies are taking advantage of people," Obama said. "We know that we have to have some form of cost containment because if we don't, then our budgets are going to blow up. And we know that small businesses are going to need help so that they can provide health insurance for their families. Those are the core, some of the core elements of this bill."
Some Republicans, who almost unanimously fought the Democratic health care legislation last year as too intrusive and too costly, have indicated support for parts of the package, including ending the practice by some insurance companies of terminating consumers' policies when they get sick.
"I believe that if the president reached out to a group of Republicans, including our leaders ... the president would find that Republicans are willing to sit down with him and talk about how to achieve a bipartisan bill," said Maine Sen. Susan Collins, a moderate Republican who supported the president's economic recovery bill last year but voted against health care.
The U.S. Chamber of Commerce, which has spent millions of dollars fighting the Democratic health care legislation, also urged a scaled back approach Wednesday.
House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev., spent the day Wednesday discussing their options with lawmakers, many of whom saw the Massachusetts result as a repudiation of the health care effort.
"We're concerned about everything going on in the country and we're not going to rush to judgment," Reid told reporters.
"People are very unsettled," said Sen. Dianne Feinstein, D-Calif., who was among the lawmakers urging a slower approach. "They are very worried. There is anger. There is angst. ... People do not understand [the health care bill]. It is so big, it's beyond their comprehension."
Sen. Mary Landrieu, D-La., said Massachusetts voters seemed to be sending the same message she heard from her own constituents: "They think parts of the health care debate are overreaching." Rep. Jim Clyburn of South Carolina, the No. 3 Democrat in the House, said he was open to a more incremental approach to health care, noting that Congress rarely enacts major policy changes in a single sweeping bill.
"Medicare was not done in one fell swoop," he said of the federal health care program for the elderly created in 1965. "You lay a foundation. You get things done."
But moving incrementally has its own dangers, since so many parts of the health care system are interrelated. Requiring insurance companies to cover more people, for example, would likely push up premiums unless more healthy people are required to buy insurance. Such a mandate could create problems unless the government provides subsidies to help people buy insurance. And that, in turn, requires new taxes or cuts to Medicare or other popular federal programs.
Democratic leaders are still exploring whether the House could pass the health care bill approved by the Senate just before Christmas, obviating the need for another vote on major health care legislation in the Senate, where Democrats would no longer be able overcome a Republican filibuster.
The two chambers could then take up a separate package of changes to the Senate bill through a process known as budget reconciliation, which only requires a simple majority in the Senate.