WASHINGTON — With a historic vote possible as early as Saturday, one Washington state representative, Brian Baird, said Friday he couldn't support the Democratic health care bill, while another, Adam Smith, said he had yet to make up his mind.
Baird said he wasn't prepared to vote for a bill until the Congressional Budget Office estimated what impact it would have on health insurance premiums, and until Medicare and Medicaid actuaries estimated the impact on those programs for seniors and low-income people.
"I can't in good conscience vote for this without those estimates," Baird said.
Smith said he is weighing whether the need to overhaul a "big, bloated, wasteful system" and provide insurance to millions currently without it outweighs the bill's $1 trillion price tag and its failure to aggressively rein in rising medical costs.
"I'm legitimately 50-50, right down the middle," said Smith, a leader among centrist House Democrats.
Both Baird and Smith are Democrats, and their votes could be critical as Democratic leaders scrambled to round up the votes needed to pass the legislation.
The Democratic bill requires that nearly everyone obtain health insurance beginning in 2013, creates a federal exchange where individuals and small businesses can purchase health care, and provides for a government-run, or public option, health care plan. The legislation also bars insurance companies from denying coverage based on pre-existing conditions, limits annual out-of-pocket costs for consumers and repeals the current antitrust exemption for health insurers.
The bill ends the current federal subsidy that has allowed Medicare Advantage to offer low rates to seniors and increases the number of people eligible for Medicaid.
Smith said he understands his support for the measure could be critical for its passage.
"Reaching 218 is tough even without me," Smith said. It takes 218 votes to pass a bill in the 435-seat House.
Smith said he has had little contact from Democratic leadership except for a phone call from House Speaker Nancy Pelosi last weekend.
"If in fact they need my vote, they haven't acted like they do," Smith said in an interview, adding he was surprised he also hadn't heard from the White House. Smith chaired President Barack Obama's campaign in Washington state during the 2008 presidential election.
Smith said he understood that if the House doesn't act, it would be a "significant setback." But he said the bill costs too much and "shies away from what needs to be done to control (medical) costs."
Though the bill provides for a study of overhauling a Medicare reimbursement formula for doctors and hospitals that has penalized Washington and other states with efficient health care systems, Smith said that was not enough.
"We dance around the edges but don't take aggressive steps to contain costs," he said.
Baird, in an interview, said he had asked House leadership and the White House to delay the vote.
"With the Senate now saying it may be January, what's the rush?" Baird said.
Baird said a person wouldn't buy a house without knowing what the monthly mortgage payment would be, and it was just as important to know the effects of the health care bill. He also said it was like chasing a train as it leaves the station.
"You need to know where it's going before you jump on," he said. "I understand the need for health care reform and I know people have worked hard. But why not wait?"
In announcing his support for the bill earlier this week, Rep. Rick Larsen, D-Wash., said the "status quo is unacceptable." He said the measure would bring "stability and security" to families struggling with increasing health care costs.
He called the inclusion of a study of Medicare reimbursement rates a "major victory" for Washington state and said that even with all the changes, the measure protects a consumer's choice of doctor and health care plan.
Rep. Norm Dicks, D-Wash., had earlier said he would support the bill.
Washington state's Republicans oppose the legislation.
The most outspoken critic was Rep. Cathy McMorris Rodgers, who likened the Democratic bill to an "internal terrorist attack."
Rep. Doc Hastings said the Democratic plan would "abolish private health insurance options" and result in a "government takeover" of the health care system.
"The federal government would therefore decide which health care plans were acceptable," Hastings said in a floor speech. "A federal commissioner would decide which health care benefits are offered and how much is charged."
A Republican plan unveiled this week was preferable, Hastings said, because it would "reduce costs, limit frivolous lawsuits, protect Medicare and help small business."
Rep. Dave Reichert, meanwhile, continued to tangle with AARP, calling the powerful senior's lobbying group's endorsement of the Democratic bill an insult to seniors.
"I'm disappointed that while AARP endorses a bill that slashes benefits of its members, its representatives still refuse to honestly answer my questions about its profit motives and how it stands to financially benefit from this bill," he said.
Reichert said that because it offers its own health care insurance plans, AARP could benefit from the Democratic bill. AARP officials have denied those allegations.