The Play-by-Play on Health Care

July 28, 2009— -- Expectations may have shifted in the debate over health care reform, but lawmakers are still eager to make at least some progress this week before Congress takes a break for the month of August.

Here's a rundown on what's really happening in Washington, when Americans can expect movement on health care bills, and whether reform will actually happen this year.

Watch "World News With Charles Gibson" tonight at 6:30 p.m. ET for the full report.

What's Happening Today:

Today six Finance Committee senators -- three Democrats and three Republicans -- continue their torturously slow march toward a bipartisan health care reform bill.

One of those Democrats, Sen. John Kerry of Massachusetts, left today's meeting and said there is agreement on about 80 percent of health reform. Kerry added that over the next hours and days, he sees further agreement emerging.

On the other side of Capitol Hill, House Energy and Commerce Chairman Henry Waxman, D-Calif., expects to hear back from moderate Democrats today after making them an offer late last night. Waxman met Monday evening with Blue Dog Democrats opposed to portions of the House plan, but they have not yet reached an agreement.

Today Rep. Mike Pence, R-Ind., said Republicans and Blue Dog Democrats were "on the verge of a historic victory" by defeating Democrats' reform plans.

Facing opposition from members of his own party, Obama held yet another town hall meeting on health care today, this time addressing the nation's retirees at the AARP.

In a brief moment of candor, Obama told them, "We're not going to have a perfect health care system. It's a complicated system. There are always going to be some problems out there. But we could be doing a lot better than we're doing right now."

Elizabeth Edwards is also scheduled to testify today before a House subcommittee about medical debt and bankruptcy.

Best-Case Scenario for Democrats:

A vote on a House bill has not been ruled out entirely, but Speaker Nancy Pelosi, D-Calif., was sounding far less optimistic Monday about that prospect than she had last week. The Senate has already said it won't be ready to bring a bill to the floor before the recess.

A more realistic best-case scenario for Democrats eager to change health care laws: If House lawmakers on the Energy and Commerce Committee could vote on their measure this week, and if the Senate Finance panel could reach an agreement, too.

In that case, both the House and Senate would come back a major step closer to voting on comprehensive measures on each side of the Hill. First, however, they need to settle disagreements about the details of the several bills being crafted.

What Happens in August:

The House is scheduled to begin its recess on Friday, the Senate a week later.

Last Friday, White House Press Secretary Robert Gibbs no one involved in health care reform planning meetings has opted to take August off. Time spent back home will also allow lawmakers to hear from constituents before returning to Washington in the fall.

Regardless, decision makers will need new momentum to accomplish their goals in September.

"Whatever they do over August is still going to require almost a complete reset in September," ABC News' George Stephanopoulos said Friday on "Top Line."

The Sticking Points:

How to pay for it. Some of the toughest opposition has come from within Obama's own party due to concerns about the cost of reform. Today the president tried to calm those fears.

"I understand people being scared that this is going to be way too costly," Obama said. "It's not that costly if we start making changes right now."

"I felt that the initial House version of the bill didn't do enough to contain costs and therefore needed too much revenue," Rep. Jared Polis, D-Colo., said Friday on ABCNews.com's "Top Line." "There's a lot of opportunities out there, including some of Obama's own proposals for cost-cutting, which weren't in the initial House version of the bill and I hope will work its way into future House versions of the bill, reducing the need to raise taxes at all."

Late Monday night, Blue Dog Democrat Rep. Mike Ross, D-Ark., said the group talked through their cost concerns with Waxman. Ross said his group is waiting for the Congressional Budget Office to prepare cost estimates of what was proposed, and will then consider what their course of action should be.

The public option: The deal now being considered by the Senate's six negotiators does not appear to include a government insurance option that Obama wanted. Instead, they are tweaking a proposal by Sen. Kent Conrad, D-N.D., to create a system of non-profit, but independent co-ops to provide insurance options outside the normal insurance industry.

Kerry, for one, prefers otherwise.

"Look my first choice is to have a public plan and to have a public option, but we all understand that there is going to be some compromise," he said today.

The public option provision faces strong opposition from most Republicans. The powerful health insurance industry, still at the table, has also made clear that a public option would be cause for the insurance industry to turn against a bill.

"We do not support a new, government-run insurance plan, but there is still the Senate Finance Committee," Robert Zirkelbach of America's Health Insurance Plans said on ABCNews.com's "Top Line." "There's a real hope that we can get bipartisan reform coming out of that committee."

To be sure, everyone has an opinion on the slew of reforms being proposed.

A Monday letter to Senate Finance Committee leaders Max Baucus, D-Mont., and Charles Grassley, R-Iowa, from the U.S. Chamber of Commerce argued that the proposal being pushed by Democrats in the House would not drive down costs and would drive private insurers out of business.

"The business community vitally needs better policy alternatives to be proposed by Congress," the letter said.

"It really matters what happens here," former President Bill Clinton said Monday at a conference focused on obesity prevention. "It matters whether we save this generation of kids. It matters whether we save our country's health system."

"Every time somebody comes along, like the president's trying to do now, and fix it, all the naysayers say, 'Oh, this is only going to make it worse and more expensive' -- as if they are totally blameless for this wonderful, beautiful Mona Lisa system we have now," Clinton said.

The Latest in the House:

Waxman said Monday night there would not be an Energy and Commerce committee markup of the bill today.

"A lot depends on when the Energy and Commerce Committee finishes its work," Pelosi said earlier Monday.

"I've also said that we need to see the direction that the Senate is going, so that we can do as much work in advance of September, so that when we come back, when we go to conference, we are a good way down the road," Pelosi also said.

On the House floor Friday, Democratic leader Steny Hoyer of Maryland noted the difficulty Democrats have had agreeing to a bill in the Energy and Commerce panel. As a result, he said, "the probably of doing that bill by the 31st [of July] is very small."

He said it is possible, however -- though not planned -- that Democrats could delay August recess and have a vote in early August.

To further complicate the matter, there are other ideas out floating around the House too that are less likely to gain traction. The conservative House Republican Study Committee plans to offer its reform plan on Thursday, the group's chairman, Rep. Tom Price, R-Ga., said today on ABCNews.com's "Top Line." House Republican leadership is also crafting a separate proposal.

"What we see [among] the moderate Democrats and certainly on our side is that we believe the American people aren't behind the bill that's before us in the House of Representatives, a bill that would in essence be a government takeover of our health care system," Price said. "And that's why you're seeing this slow-down on the House side."

The Latest in the Senate:

The Senate's six negotiators are trying to figure out how to pay for an overhaul and control insurance companies without a public insurance option. On Monday, Sen. Max Baucus, D-Mont., said he's been talking to President Obama almost daily about the talks.

Some details are starting to emerge, though nothing is final. Negotiators seem to be rejecting a so-called mandate for employers to provide insurance for their employees. But there is apparent agreement that employers who drop coverage for employees should have to cover the cost of any government subsidy their employees would qualify for under reform. There is also talk of not taxing the people who receive pricey insurance plans, but rather taxing insurance companies that offer them.

Last Thursday, Senate Majority Leader Harry Reid said the new goal was to have a bill passed out of the Finance Committee by Aug. 7. Reid said he would then merge the Finance bill and the other Senate bill that's already been approved by the Senate's health panel so that senators would be ready for September..

Today he added that in order for that to happen, Democrats, including himself, will have to make some sacrifices.

"I have a responsibility to get a bill on the Senate floor that will get 60 votes, so we can proceed to it," Reid said. "That's my number one responsibility and there are times when I have to set aside my personal preferences for the good of the Senate and I think the country."

Senate Democrats are also acutely aware that Sen. Ted Kennedy's absence due to his illness could ultimately make or break the measure. They're hopeful that he can get to Washington when it's time for a vote.

Health care reform's foremost champion, Kennedy is closely tracking negotiations and has spoken twice with Obama by telephone over the past two weeks.

"One of the biggest problems is unifying the Democrats," said Sen. Orrin Hatch, R-Utah. "And to be honest with you, he's the only person I know in the Democratic Party who could bring together its five largest groups."

Republicans, meantime, remain cautious.

"This is the biggest issue, arguably, the biggest domestic issue, we'll ever have," Senate Minority Leader Mitch McConnell, R-Ky., said today. "Sixteen percent of our economy, everybody cares about health care, it affects each of us in a very personal way… And what we hear from the American people, they're saying, 'Whoa, slow down, make sure of what you're doing before you go forward,' because many of Americans are concerned they're going to lose their own health care."

The Latest From the White House:

Obama plans to travel to North Carolina and Virginia Wednesday for more health care events. Gibbs said today the president will continue to make his case for health care reform until he gets a bill.

The White House is pitching its plan to various demographic groups, including, for instance, small business owners.

"The vast majority of small businesses, they'll see their burdens absolutely lessened by the expansion of coverage," Dr. Christina Romer, chairwoman of the President's Council of Economic Advisers, said Monday. "So they are absolutely going to be more competitive."

On Thursday, Obama said it was "OK" if senators postpone the vote until after his initial August deadline.

"My attitude is, I want to get it right, but I also want to get it done promptly," Obama said at a town hall meeting Thursday in Cleveland. "And so as long as I see folks working diligently and consistently, then I am comfortable with moving a process forward that builds as much consensus as possible."

ABC News' Jonathan Karl, John Hendren, Jake Tapper, Karen Travers, Rick Klein, Yunji de Nies, Theresa Cook and Huma Khan contributed to this report.