While Confident Health Care Will Pass This Year, Democrats Still Search for a Plan

WASHINGTON — Democratic leaders in Congress voiced resolute optimism on Thursday that they would adopt major health care legislation this year, and they said that doing so was a crucial element of President Obama’s broader agenda to create jobs, revive the economy and reduce federal budget deficits.

But legislative leaders conceded that they did not have an immediate strategy for advancing a health care measure and described their time frame as open-ended.

Speaker Nancy Pelosi, at a news conference in the Capitol, said House Democrats had begun exploring the possibility of breaking out pieces of the comprehensive bill they passed in November and moving forward on smaller measures.

“It means, we will move on many fronts, any front we can,” Ms. Pelosi said. “We’ll go through the gate. If the gate’s closed, we’ll go over the fence. If the fence is too high, we’ll pole-vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people, for their own personal health and economic security, and for the important role that it will play in reducing the deficit.”

Aides said that a first candidate for a stand-alone measure could be the proposal to eliminate the exemption from federal antitrust law that health insurance companies have long enjoyed. Such a proposal was incorporated in the larger House health care bill.

The Senate considered a similar proposal but did not include it in the bill it passed on Dec. 24.

In keeping with the tone of Mr. Obama’s State of the Union address, the Senate majority leader, Harry Reid of Nevada, placed health care in the context of a broader agenda focused on jobs and the economy.

Mr. Reid met Thursday with his top advisers and Senate committee chairmen to discuss the health care legislation, but made no decisions about how to proceed, aides said.

“We’re going to do health care reform this year,” Mr. Reid said at a news conference. “The question is, At this stage, procedurally, how do we get where we need to go.”

The Republican victory in the Massachusetts special Senate election last week means that Democrats will soon lose their 60-vote majority, which they need to overcome Republican filibusters. But even if they could surmount Republicans opposition, Senate and House Democrats have yet to bridge the differences between their bills.

“We’re not talking about minor tweaks,” Ms. Pelosi said. “It’s more serious than that.”

Though tensions between the two chambers have been running high, Ms. Pelosi did not criticize the Senate.

“The rules of the House enable more expeditious passage of legislation,” she said. “The Senate takes longer. That’s what our founders built into the system.”

So, Ms. Pelosi added, “I don’t want to waste any energy on criticizing the Senate.”

The speaker said the health care legislation would create four million jobs over 10 years. “We must pass health care reform,” she said. “We cannot sustain financially the current system.”

At a town-hall-style meeting in Tampa, Fla., on Thursday, Mr. Obama said he was intent on winning passage of a health care bill this year.

“If you are serious about reducing our deficit and debt,” he said, “you cannot accomplish it without reforming our health care system, because that’s what’s gobbling up more federal dollars than anything else.”

The House Republican leader, Representative John A. Boehner of Ohio, said he detected no material change in Mr. Obama’s approach.

“Unfortunately,” Mr. Boehner said, “the president does not appear to have listened to what the people in Massachusetts have said.”

One potential route for Democrats would be to have the Senate adopt changes to its health care measure as part of a budget bill, which could be approved with a simple majority vote.

But some centrist Democrats, like Senators Evan Bayh of Indiana and Blanche Lincoln of Arkansas, have said they oppose that approach.

Another centrist Democrat, Senator Ben Nelson of Nebraska, said Thursday that he, too, would oppose use of the expedited budget procedure. He urged Senate Republicans to work with him instead.

“If Republican colleagues are serious about fixing our health care system and want to avoid using the reconciliation process,” Mr. Nelson said, “then I will go to the negotiating table with them. If Republican senators join me at the table, we can use bipartisanship for health reform rather than use reconciliation, which needs only 50 votes.”