Congressional Democratic leaders are eyeing the finish line to health care legislation following President Obama's outline last week of a reform bill that included some Republican priorities and his call for a "simple majority" vote on reform this month.

In a March 3 speech in the East Room of the White House, Obama said health care legislation "deserves the same kind of up-or-down vote that was cast on welfare reform, that was cast on the Children's Health Insurance Program, that was used for COBRA health coverage for the unemployed, and by the way for both Bush tax cuts - all of which had to pass Congress with nothing more than a simple majority."

The president said he had asked leaders in both of chambers of Congress to finish their work and schedule a vote in the next few weeks.

Some GOP ideas. Obama last week unveiled a broad outline of his roughly $950 billion reform blueprint, which included some Republican policy priorities. The president said he is open to GOP-inspired proposals to provide an additional $50 million in grants for medical liability demonstrations; ways to increase doctor reimbursement if Medicaid is expanded; allowing high-deductible health plans to participate in the health insurance exchange; and using "medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid and other federal programs."

Obama's plan would create state-run health insurance exchanges, a phase-in tax on expensive insurance plans, increased Medicare taxes on investments for high-income taxpayers, new federal subsidies for low-income families and fines for failing to obtain coverage. It is largely based on the Senate's "Patient Protection and Affordable Care Act," H.R. 3590. Congressional Republicans were not impressed with the plan and reiterated their call for Democrats to discard the bills adopted by the House and Senate and start over with a step-by-step approach.

Democrats want to pass a reform bill before the spring recess that begins March 27. Barring an agreement with Republicans, Democrats are likely to use a two-bill approach to secure passage of an overhaul.

Reconciliation. The strategy calls for House Democrats to pass unchanged the Senate's reform bill and send it directly to the president for his signature. The Senate then would approve a separate package of reform measures through the budget reconciliation process, which requires only a simple majority for passage. The changes would bridge differences between the House and the Senate and incorporate some of the president's proposals.

Complicating the effort is that both sides of Congress have doubted that their colleagues in opposing chambers will hold up their end of the bargain.

Although reconciliation bills are protected from filibusters, they are subject to numerous other restrictions. Under reconciliation rules included in the current budget, the package of fixes would have to meet an overall goal of cutting the deficit by at least $2 billion over the next 10 years. And Republicans can delay a final vote by raising procedural objections and offering numerous amendments.

Repealing antitrust exemption. The House reform bill, passed last November, includes a measure to limit health insurers' antitrust exemption. Looking to advance some key elements of reform on a piecemeal basis in case comprehensive reform flounders, the House late last month voted 406 to 19 to approve standalone legislation that would repeal the antitrust exemption available to health insurers for anticompetitive conduct, including price fixing, bid rigging and market allocation. The "Health Insurance Industry Fair Competition Act," H.R. 4626, was sponsored by Reps. Tom Perriello, D-VA, and Betsy Markey, D-CO.

Expressing its support for the bill in a Feb. 23 letter to House Speaker Nancy Pelosi, D-CA, Judiciary Committee Chairman John Conyers, D-MI, Perriello and Markey, the AHA said "the health insurance industry should be governed by the same antitrust laws and policies that apply in other sectors of our economy, including health care. Any exemptions should be narrow and carefully tailored to achieve a pro-competitive purpose."