WASHINGTON — Fiscally conservative House Democrats forced leaders of their party on Tuesday to slow the pace of work on major health care legislation so Congress and President Obama could address their concerns about the cost of the bill, its impact on small businesses and the shape of a proposed new government health insurance plan.
The fiscal conservatives, members of the House Blue Dog Coalition, made their case for major changes in the bill at a White House meeting with Mr. Obama.
The chairman of the House Energy and Commerce Committee, Representative Henry A. Waxman, Democrat of California, canceled sessions of the panel scheduled for Tuesday and Wednesday so he could meet with Blue Dogs. They hold seven seats on the committee, a potentially decisive number, since the panel has 36 Democrats and 23 Republicans.
“The seven of us cannot support the current House bill,” said Representative Mike Ross, Democrat of Arkansas, who is the point man on health care for the Blue Dogs. “Whether it requires a new bill or whether this bill can be amended, those are decisions, I guess, for the parliamentarians to help us make.”
“We don’t need to box ourselves in with any artificial deadline,” Mr. Ross added.
The Blue Dogs said they had won agreement from Mr. Waxman to help rein in Medicare spending by giving the executive branch new power to set annual payment rates for doctors, hospitals and other health care providers, based on recommendations from an independent advisory council. Rates are now set by statutory formulas, and Congress is besieged by lobbyists pleading for bigger increases each year.
It was unclear when the energy committee sessions would resume, but even the two-day delay was a setback for House Democratic leaders, who had hoped to pass the bill before their summer recess, scheduled to begin at the end of next week.
If the committee finishes its work in the next few days, the House could still vote on the legislation next week and thus meet a goal set by Mr. Obama. The House Democratic leader, Representative Steny H. Hoyer of Maryland, said he saw no point in staying in session longer to grapple with health care.
“If we get consensus, we’ll move on it” next week, Mr. Hoyer said. “If we don’t get consensus, I don’t think staying in session is necessarily necessary.”
In an e-mail message, David L. Cavicke, chief of the Republican staff at the energy committee, declared “a victory.”
“The majority obviously does not have the votes, even with a 13-vote advantage in committee, to move this trillion-dollar socialization of American heath care,” Mr. Cavicke said, and he thanked Republicans for sticking together.
The chairman of the Senate Finance Committee, Senator Max Baucus, Democrat of Montana, met throughout the day with a handful of members of his panel and said they were making slow but steady progress toward a bipartisan proposal.
But some Republicans, like the House minority leader, Representative John A. Boehner of Ohio, said the president’s plan was a bad foundation on which to build because it would kill jobs by imposing new costs on employers, requiring them to provide or help pay for insurance for their workers. “It’s time to scrap this bill,” Mr. Boehner said.
Mr. Obama tried again to whip up public support for the legislation, which is his top domestic priority.
“I understand that some will try to delay action until the special interests can kill it, while others will simply focus on scoring political points,” Mr. Obama said before television cameras in the Rose Garden of the White House. “We’ve done that before.”
Alternatively, “we can choose action over inaction,” he said. “We can choose progress over the politics of the moment. We can build on the extraordinary common ground that’s been forged.”
The White House, which has been wooing interest groups from the health care industry, began to see Tuesday how difficult it would be to keep a united front.
Dr. J. James Rohack, president of the American Medical Association, issued a video message supporting the House bill.
“The status quo is unacceptable,” Dr. Rohack said in the video, posted on YouTube and the association’s Web site. “Without a bill that can pass the House, there is no health reform this year.”
But six state medical societies and two former A.M.A. presidents sent a letter to Mr. Waxman opposing a government-run health plan and any requirement for individuals or employers to buy insurance. The societies include doctors in Alabama, Delaware, Georgia, Kansas, New Jersey and South Carolina.
“Very soon after the government places mandates on individuals or employers,” said Dr. M. Todd Williamson, a neurologist who is president of the Medical Association of Georgia, “we will see government dictating care, what’s going to be covered or provided.”
Lawmakers are frantically looking for ways to cut Medicare or raise new tax revenue to cover the cost of subsidizing insurance for tens of millions of Americans.
Mr. Baucus originally wanted to tax some employer-provided health benefits. Labor unions resisted that idea, and the Senate Democratic leader, Harry Reid of Nevada, raised objections.
As an alternative, Senator John Kerry, Democrat of Massachusetts, proposed an excise tax on insurance companies that offer coverage far exceeding the value of the average policy, now about $13,000 a year for a family.
Mr. Kerry contends that such a tax would put pressure on insurers to reduce the cost of their health plans, lower premiums and reduce the overall cost of health care.