WASHINGTON (AP) -- Time growing short, Democratic leaders in Congress are still grappling with divisive issues as they try to achieve President Barack Obama's ambitious goal of passing legislation to remake the U.S. health care system by year's end.
Both House of Representatives Speaker Nancy Pelosi and Senate Majority Leader Harry Reid are expected to make key decisions this week in hopes the long-delayed health care bills can come to a vote in early November.
Obama has made overhauling the country's health care system his top domestic priority and the outcome is likely to affect how his fellow Democrats will fare in congressional elections next year. Most Americans rely on private insurance, usually provided through their employers. The government insures the elderly and indigent, but nearly 50 million Americans have no health insurance at all.
Numerous questions remain unanswered before that can happen, particularly in the Senate, where Reid, two committee chairmen and senior White House officials are trying to craft legislation that can achieve Obama's objectives and command the 60 votes needed (out of a possible 100) to overcome any Republican delaying tactics.
In general, the bills taking shape in both houses are intended to expand coverage to millions who lack it, ban insurance industry practices such as denial of coverage for pre-existing medical conditions and slow the growth in medical spending.
They would create a new federally regulated marketplace, termed an exchange, where individuals and families could purchase insurance sold by private industry. Federal subsidies would be available to help those at lower incomes afford the cost.
Subsidies would also be available to smaller businesses as an incentive for them to provide insurance.
Officials familiar with the talks say businesses would not be required to provide health insurance under legislation being readied. But large firms would owe significant penalties if any worker needed government subsidies to buy coverage on their own.
For firms with more than 50 employees, the fee could be as high as $750 multiplied by the total size of the work force if only a few workers needed federal aid, these officials said. That is a more stringent penalty than in a bill that recently cleared the Senate Finance Committee, which said companies should face penalties on a per-employee basis.
These officials also said individuals would generally be required to purchase affordable insurance if it were available, and face penalties if they defied the requirement.
The officials spoke on condition of anonymity, saying they were not authorized to discuss the private negotiations involving key Senate Democrats and the White House. They also stressed that no final decisions have been made on the details of the measure.
Obama has set a spending limit of roughly $900 billion over a decade for the legislation.
He also appears willing to bow to the wishes of House Democrats, whose bill is expected to total roughly $1 trillion. Democrats argue some of that spending shouldn't be counted against Obama's total because it doesn't deal directly with the cost of providing coverage.
It covers items such as improved benefits for the government's insurance programs for the elderly and indigent, as well as money spent on disease prevention programs.
