The House speaker, Nancy Pelosi of California, said on Thursday that Democrats remained committed to passing far-reaching health care legislation, but she said that the House would not simply adopt the Senate version of the bill and send it to President Obama in part because of problematic provisions that she said contributed to the Republican victory in the Massachusetts special election on Tuesday.
“We recognize health care has to be done, health care reform must be done,” Ms. Pelosi said at her weekly news conference in the Capitol.
However, she said that party leaders and rank-and-file lawmakers had not decided how to proceed given the opposition to simply passing the Senate bill and the fact that Senate Democrats, as a result of the outcome in Massachusetts, will no longer control the 60 votes needed to surmount a Republican filibuster and approve a revised bill.
“Unease would be a gentle word in terms of the attitude of my colleagues toward certain provisions in the Senate bill,” Ms. Pelosi said.
“So in its present form without any change,” she added, “I don’t think it’s possible to pass the Senate bill in the House.”
She singled out a provision for the federal government to pay the entire cost of a proposed expansion of Medicaid in Nebraska, even though other states will eventually have to share the expense, which was added to the Senate bill by the majority leader, Harry Reid of Nevada, to win the vote of Senator Ben Nelson, the Nebraska Democrat.
Ms. Pelosi said she believed provisions like that contributed to the concerns of voters in Massachusetts.
“There’s some fundamentals in there that make it problematic for our members,” Ms. Pelosi said. “Some members say, and I respect this, some of the concerns that were expressed in Massachusetts were about certain provisions of the Senate bill. We want, obviously, to hear and heed what was said there and what is said across the country.”
Speaking of her rank-and-file, she added, “They don’t see why something that wasn’t even a fundamental part of the bill to begin with, that has been rejected by the American people, is something they should be called upon to vote for.”
Ms. Pelosi acknowledged that some Democrats, including President Obama, have suggested the possibility of moving forward with a pared-back health care bill. The White House has stressed that Mr. Obama still prefers a sweeping overhaul.
But at her news conference, Ms. Pelosi said that Democrats remain committed to making crucial improvements to the health care system, which require doing more than just the parts of the legislation that could pass easily with bipartisan support.
“Certainly there would be great consensus to take the most popular part of the bill and advance it and that would be positive,” she said. “But we have serious other structural things that have to be done, systemic changes.”
And unlike Mr. Reid, who on Wednesday suggested that the Senate was prepared to move forward with a broader agenda focused on jobs and the economy, Ms. Pelosi pointedly reiterated her commitment to completing the health care legislation.
“We are going to have to continue to go in a forward direction to lower costs, to hold the insurance companies accountable, to make sure what we do is affordable to the middle class and as we expand access to quality, affordable health care,” she said. “It’s still a very exciting initiative, ranks right up there with Social Security and Medicare, and we are meeting with our members at the caucus and different groups of the caucus to hear how they perceived the best way and how they would prefer to go forward. But we will go forward.”