WASHINGTON - The House Committee on Education and Labor approved legislation on Friday morning to remake the nation's health care system by a vote of 26 to 22. Three Democrats crossed party lines and voted against the bill - Jason Altmire of Pennsylvania, Jared Polis of Colorado and Dina Titus of Nevada.
The vote came eight hours after the House Ways and Means Committee approved the measure, 23 to 18, with three Democrats voting no. The dissident Democrats were Ron Kind of Wisconsin, Earl Pomeroy of North Dakota and John Tanner of Tennessee.
Democrats who voted against the bill cited such concerns as the tax increases, their effect on small businesses and the possibility that a new government-run health insurance plan might underpay doctors and hospitals by using Medicare reimbursement rates.
Of the five Congressional committees working on the legislation, three have now approved it.
On Thursday, a party-line Senate committee vote on health care legislation also underscored the absence of political consensus on what would be the biggest changes in social policy in more than 40 years.
The bill, which aims to make health insurance available to all Americans, was approved, 13 to 10, by the Committee on Health, Education, Labor and Pensions. The panel was the first Congressional committee to approve the health legislation.
"If you don't have health insurance, this bill is for you," said Senator Christopher J. Dodd, Democrat of Connecticut, who presided over more than three weeks of grueling committee sessions. "It stops insurance companies from denying coverage based on pre-existing conditions. It guarantees that you'll be able to find an insurance plan that works for you, including a public health insurance option if you want it."
The bill would also help people who have insurance, Mr. Dodd said, because "it eliminates annual and lifetime caps on coverage and ensures that your out-of-pocket costs will never exceed your ability to pay."
But the partisan split signified potential trouble ahead. Republicans on the panel, who voted unanimously against the measure, described the idea of a new public insurance option as a deal-breaker. They said they still hoped that a consensus bill would emerge from the Senate Finance Committee.
The health and finance committees share jurisdiction over health issues. The finance panel, the next step on the way to passage of any measure, is now the focus of intense scrutiny. It must say how it intends to pay for its proposals and, unlike the health panel, has the power to do so because it can write tax legislation and has authority over Medicare and Medicaid.
President Obama hailed the Senate health committee's action, but reiterated his insistence that each chamber of Congress approve a health care bill before the August recess. His comments increased pressure on the chairman of the Finance Committee, Senator Max Baucus, Democrat of Montana, who has been struggling for months to get a bipartisan bill.
"The HELP committee's success should give us hope, but it should not give us pause," Mr. Obama said. "It should instead provide the urgency for both the House and Senate to finish their critical work on health reform before the August recess."
Senators said the White House had been sending mixed signals. For months, they said, it emphasized the need for a bipartisan bill. But in the last 10 days, one Democrat said, the message has been: "Hurry up. If you have to go without Republicans, it's not the end of the world."
As a presidential candidate, Mr. Obama boasted of his ability to transcend partisan splits that had stymied action in Washington. At a candidates' forum in Las Vegas in March 2007 - even before he had a detailed health care proposal - Mr. Obama declared that "the most important challenge is to build a political consensus" on covering all Americans.
The Senate majority leader, Harry Reid of Nevada, has said he hopes to have a health care bill on the floor by July 27. That goal appears unrealistic, even though members of the Finance Committee said they were making progress in talks on how to pay for their bill, expected to cost at least $1 trillion over 10 years.
Several Democratic Finance Committee members, including Kent Conrad of North Dakota and Charles E. Schumer of New York, said they were intent on reaching an agreement with Republicans and were more concerned about the contents of the bill than the timetable.
It is unclear how long the White House and Democratic leaders in Congress will give Mr. Baucus to work things out. The senator said he was still optimistic about winning support from several Republicans on his committee like Charles E. Grassley of Iowa and Olympia J. Snowe of Maine.
Mr. Schumer said: "There's a strong preference for bipartisanship because it makes the bill easier to pass. But if we cannot get bipartisanship, we must forge ahead because health care reform is too important."
Republicans said they were prepared for the possibility that Mr. Baucus or leaders of his party would lose patience and plow ahead on their own, in the absence of a bipartisan agreement.
"Time is fleeting," Mr. Grassley said, praising Mr. Baucus's efforts. On the most contentious issues, like the proposal for a new public insurance plan, he said, Mr. Baucus has shown that "he is willing to find a middle ground; he's not an ideologue."
Mr. Dodd said it was more important to get "a good bill" than a bipartisan one, even as he acknowledged that a bill with bipartisan support would be more sustainable in the long run.
"There's a value in achieving bipartisanship," Mr. Dodd said, "but I will not sacrifice a good bill for that. The people we are working for are not our colleagues, but the American public." Mr. Dodd presided in the absence of Senator Edward M. Kennedy, Democrat of Massachusetts, the longtime champion of universal coverage who is battling cancer.
White House officials said they had a new standard for bipartisanship: the number of Republican ideas incorporated in the legislation, rather than the number of Republican votes for a Democratic bill. Mr. Obama said the health committee bill "includes 160 Republican amendments," and he said that was "a hopeful sign of bipartisan support for the final product."
Republicans said many of those amendments were technical, and they were scathing in their criticism of the bill approved by the health committee.
With a hint of sarcasm, Senator Michael B. Enzi of Wyoming, the senior Republican on the panel, noted that the bill's title was the Affordable Health Choices Act. But "with its trillion-dollar price tag," he said, "this bill is anything but affordable."
"The bill gets an F," Mr. Enzi said.
Senator Orrin G. Hatch of Utah, a Republican who has teamed up with Democrats to pass major health care bills over the last 25 years, said the measure approved Wednesday was "totally partisan."
"From the start of the health care debate," Mr. Hatch said, "Democrats have completely shut us out of the process."
Senator Judd Gregg, Republican of New Hampshire, said the bill would not provide universal coverage or reduce health costs, but would result in some Americans' losing insurance or even their jobs. "Small business will be massively impacted," Mr. Gregg said.
Senator Barbara A. Mikulski, Democrat of Maryland, said the Republicans were sore losers. "We gave them hours of debate and opportunities to offer unlimited amendments," she said. "At the end of the day, they did not want to support universal health coverage."