Health Policy Now Carved Out at a More Centrist Table

WASHINGTON — On the agenda is the revamping of the American health care system, possibly the most complex legislation in modern history. But on the table, in a conference room where the bill is being hashed out by six senators, the snacks are anything but healthy.

Last week, there were chippers — chocolate-covered potato chips — described on a sign as “North Dakota Diet Food.” More often, there are Doritos, pretzels, Oreo cookies and beef jerky: fuel to get through hours of talks on topics like the actuarial values of private insurance plans or the cost-sharing provisions of Medicare.

The fate of the health care overhaul largely rests on the shoulders of six senators who since June 17 have gathered — often twice a day, and for many hours at a stretch — in a conference room with burnt sienna walls, in the office of the Senate Finance Committee chairman, Max Baucus, Democrat of Montana.

President Obama and Congressional leaders agree that if a bipartisan deal can be forged on health care, it will emerge from this conference room, with a huge map of Montana on one wall and photos of Mike Mansfield, the Montanan who was the longest-serving Senate majority leader, on the other.

The battle over health care is all but paralyzed as everyone awaits the outcome of their talks.

Mr. Baucus says his group will produce the bill that best meets Mr. Obama’s top priorities, broadly expanding coverage to the uninsured and curtailing the steep rise in health care spending over the long term, what policy makers call “bending the cost curve.”

Still, if the three Democrats and three Republicans can pull off a grand bargain, it will have to be more conservative than the measures proposed by the House or the left-leaning Senate health committee. And that could force Mr. Obama to choose between backing the bipartisan deal or rank-and-file Democrats who want a bill that more closely reflects their liberal ideals.

Already, the group of six has tossed aside the idea of a government-run insurance plan that would compete with private insurers, which the president supports but Republicans said was a deal-breaker.

Instead, they are proposing a network of private, nonprofit cooperatives.

They have also dismissed the House Democratic plan to pay for the bill’s roughly $1 trillion, 10-year cost partly with an income surtax on high earners.

The three Republicans have insisted that any new taxes come from within the health care arena. As one option, Democrats have proposed taxing high-end insurance plans with values exceeding $25,000.

The Senate group also seems prepared to drop a requirement, included in other versions of the legislation, that employers offer coverage to their workers. “We don’t mandate employer coverage,” Senator Olympia J. Snowe, Republican of Maine and one of the six, said Monday. Employers that do not offer coverage may instead have to pay the cost of any government subsidies for which their workers qualify. In the House, centrist Democrats have temporarily stalled the health care bill, many lawmakers want to see what Mr. Baucus’s group produces before voting on tax increases in the House bill.

Mr. Obama, in his news conference last week, praised the three Republicans in the Senate group — Michael B. Enzi of Wyoming, Charles E. Grassley of Iowa and Ms. Snowe. Mr. Grassley, the senior Republican on the Finance Committee, and Mr. Baucus share a history of deal-making, and group members said they share a sense of trust despite the partisan acrimony that pervades the Capitol.

Mr. Enzi, who sits on both the Finance Committee and the health committee, has a long record on health issues but found Democrats on the health panel unwilling to compromise.

And Ms. Snowe, one of two centrist Republicans, often teams with Democrats as she did on the economic stimulus plan this year.

After the group insisted it needed more time, the majority leader, Senator Harry Reid of Nevada, conceded that a floor vote would have to wait until after the summer recess. “If this is the only bill with bipartisan support,” Ms. Snowe said, “that will really resonate. It could be the linchpin for broad bipartisan agreement.”

In addition to Mr. Baucus, the Democrats are Senators Kent Conrad of North Dakota and Jeff Bingaman of New Mexico.

“I think there’s a heavy sense of responsibility among this group,” Mr. Conrad said in an interview. “Our country needs us to get this right.”

As they near a deal, however, Mr. Baucus is getting resistance from Democrats who think he is giving too much ground.

Mr. Grassley said the group agreed on how to achieve most of the larger policy goals, including barring insurance companies from denying coverage based on pre-existing conditions and better managing treatment of costly chronic diseases like diabetes and asthma. But there have been sharp disagreements, particularly over how to pay for the legislation.

Often a single topic can consume an entire day or more. On Wednesday of last week, it was Medicaid, the federal-state insurance program for low-income people that was likely to be expanded but was also a major factor in the legislation’s high cost.

Another recent topic has been how to create payment incentives for doctors and other providers to work in collaborative teams, as part of so-called accountable care organizations.

“The talks are free-flowing,” Ms. Snowe said. “Max is very inclusive,” she said of Mr. Baucus.

Members of the group methodically work through issues. When they reach a tentative agreement, Mr. Baucus asks, “Can I put down a ‘T’?”

“It’s very businesslike,” Mr. Conrad said. “Everybody participates. One senator might carry a discussion. Others chime in. Senator Baucus, the chairman, is the leader, but he rides with a very light rein.”

Typically, they gather at 10 a.m., break around noon for meetings, lunches and votes, and then resume at 2:30. Each senator now claims the same seat — “just like kids in school,” Ms. Snowe said in an interview.

Then, there are the refreshments. The coffee, brewed in the office, is roasted in Montana, usually the Grizzly or Buffalo blends.

For all the discussions about preventive medicine, and the need to encourage Americans to lead healthier lives, carrots and celery sticks are not typical.

“The food leaves something to be desired,” Ms. Snowe said. But she also noted that no one was in the room to eat.

“There are not many occasions when we have the opportunity to sit down and immerse ourselves in an issue like this, an issue that has profound implications for the country, with historic overtones, to say the least,” Ms. Snowe said. “I feel privileged to participate.”