President Barack Obama has tried to create momentum for the broader package this week, but there was little evidence on Capitol Hill that his 7 1/2-hour bipartisan summit on Thursday had accomplished much.

"I don't think the summit changed anything," said Rep. Jason Altmire, D-Pa., one of 54 members of the House of Representatives Blue Dog Coalition of moderate-to-conservative Democrats. "We still have a problem. The summit was a recitation of talking points on both sides, and there was no new information."

What the moderates liked – as do many Republicans – is a series of popular changes. The first came earlier this week when the House overwhelmingly approved stripping health insurance companies of their antitrust exemption. The next could permit children to remain on their parents' insurance policies through their mid- to late 20s.

The major Democratic focus, though, will be on the larger package. The Senate and House passed different versions of health care legislation late last year, but it's languished as the two houses have been unable to compromise.

Democratic leaders Friday said they were newly optimistic.

"I think we're ready now for the big game. We're ready for the finale," said House Rules Committee Chairman Louise Slaughter, D-N.Y. "What the summit did is give us a little more spine," added Rep. Bill Pascrell, D-N.J.

House Speaker Nancy Pelosi, D-San Francisco, said that Obama's health care plan, released Monday, addresses several key House Democratic concerns. Among them: changing the Senate plan to tax high-end policies, although that wouldn't take effect until 2018 and would apply only to premiums of more than $10,200 for individuals and $27,500 for families.

Passing any legislation, though, will be difficult; not only because of centrist hesitation, but because it's unlikely that Senate Democrats can muster the 60 votes that are needed to cut off debate.

Senate leaders are considering using a process called reconciliation to pass the health legislation because that would require only 51 votes and Democrats control 59 seats. But that would limit the scope of what could be passed.

The Republican governor said on NBC's "Meet the Press" that the U.S. Senate's proposed federal health care overhaul would saddle the state with an extra $3 billion to $4 billion in annual costs due largely to an expansion of Medicaid, known as Medi-Cal in California. Schwarzenegger believes the health care plan would enshrine existing cost-share formulas that he says are unfair to the state.

The governor has attacked changes won by Sen. Ben Nelson, a Nebraska Democrat, particularly one that would exempt Nebraska from additional Medicaid costs. Schwarzenegger said California's congressional members "are not representing us really well in this case."

He added, "I cannot imagine why … our senators and congressional people, how they would vote for something like that where they are representing Nebraska and not us. And, by the way, as I said in my State of the State, that's the biggest rip-off. I mean, that is against the law to buy a vote."

Schwarzenegger's comments in recent days have sparked a rebuttal from California's Democratic U.S. senators, Barbara Boxer and Dianne Feinstein.

The governor said California receives only 78 cents back for every dollar its taxpayers send to Washington, based on a study released by the Tax Foundation. The figure is from 2005.

Boxer, running for re-election this year, on Friday released a study she commissioned estimating that California received $1.02 per federal tax dollar in 2008 and $1.45 in 2009, with the latter number including federal stimulus dollars. Feinstein last week said, "California's budget crisis was created in Sacramento, not Washington."

Health Access California, an advocate for low-income residents, disputed Schwarzenegger's estimates. The group said that the federal government would pay for most of the expansion costs and that the state would not face added expenses until 2018-19.

Schwarzenegger is attacking the health care bill to make a broader case for more money from the federal government as the state desperately tries to plug a $19.9 billion budget deficit.

Schwarzenegger said he plans to travel to Washington with the state's four legislative leaders to lobby federal officials and the state's congressional delegation.

Entering his final year, Schwarzenegger said, "Even though California is known as a state that is not governable – it is very hard to govern California, probably the toughest state to govern – but still we got a lot of things done."

He then pulled out a paper to-do list from his coat pocket in which nine of 13 items were checked off, six of which were related to public works bonds. His unchecked items were "budget reform," "tax reform," "open primaries" and "campaign finance reform."

Asked whether he would run again for political office, Schwarzenegger said, "Well, you never say never. But I mean, you know, right now I have no plans, period."

The House of Representatives passed its own overhaul plan last month.

One threat to eventual passage is the public's view of the legislation, said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan Washington research group.

It could take several weeks for the conference to produce a bill, and "that's a long time for public opinion to shift," he said, and its success, particularly in an election year, will depend on "how this plays out with the public over the next few months."

Signs of what could happen next are mixed.

"There's pretty broad agreement on a lot," said Elizabeth Carpenter, a health policy analyst at the New America Foundation, a center-left Washington research group. Under both bills, insurers would be barred from rejecting anyone because of pre-existing conditions. Gone, too, would be the practice in many states of charging women more than men, and insurers would be limited in how much they could increase rates on older people.

Consumers would be able to shop for coverage through exchanges, much as they now scan the Internet for the best airline fares. Most people would have to obtain a certain level of coverage, and they would have to pay penalties if they fail to do so.

Both houses agree on financial help for people having trouble affording coverage: They both would provide aid to families earning up to about $88,000 per year.

What could derail the entire effort are areas in which Democratic leaders have struggled for months to find common ground: abortion, taxes and the public option.

Ultimately, Democrats will write the final bill, because they control 60 Senate seats – enough to cut off filibusters – and 258 of the House's 435 seats. However, that means appealing to the 52 moderate-to-conservative Blue Dogs in the House, as well as to the eight to 12 centrist Democrats in the Senate.

That's likely to mean important concessions on the three big sticking points.

Already, liberals' yen for a government-run insurance alternative and giving women more access to elective abortions faded when moderate senators balked.

Sen. Ben Nelson, D-Neb., who over the weekend provided the crucial 60th vote to cut off debate, explained a big reason he went along: "The Senate health care bill is not perfect. Yet it doesn't include a public option or taxpayer funding of abortion I worked to exclude."

One of the public option's biggest boosters, Sen. Russell Feingold, D-Wis., realized that without the moderates, the entire health care bill could be defeated. "While the loss of the public option is bitter pill to swallow, on balance the bill still delivers meaningful reform, and the cost of inaction is simply too high," he said.

What all this means, said Barbara Kennelly, the president of the Committee to Preserve Social Security and Medicare, is that bill supporters need to be reminded, "This is truly an opportunity to begin health care reform."

That desire to at least provide a foundation for future action is what worries skeptics.

Abortion-rights supporters worry that the Senate bill doesn't go much further than the House version, which restricts federal funding to instances in which a woman's life is in danger or she's a victim of rape or incest. Abortion opponents think the Senate bill, which has somewhat less restrictive requirements, goes too far.

Taxpayer groups see too many taxes going up, since the House version imposes a 5.4 percent surcharge on individuals with adjusted gross incomes of more than $500,000 and couples making more than $1 million.

The Senate version includes a 40 percent excise tax on more expensive insurance policies and a 0.9 percentage point increase in the 1.45 percent Medicare tax for individuals with wages of more than $200,000 and couples earning more than $250,000.

"Democratic leaders put together a bill so heavy with tax hikes, Medicare cuts and government intrusion that in the end their biggest problem wasn't convincing Republicans to support it, it was convincing Democrats," scoffed Senate Republican leader Mitch McConnell, R-Ky.

However, Senate Majority Leader Harry Reid, D-Nev., was cheered Monday by a new CNN/Opinion Research Corp. poll, which found that support for the Democrats' health care bill was up six percentage points over the last two weeks.

That poll, though, also showed Democrats have a long way to go, as 56 percent still oppose the bill, while 42 percent support it.

WASHINGTON – Hope grew Wednesday for Senate passage of a historic restructuring of the nation's health insurance system, as key lawmakers praised and President Barack Obama endorsed a tentative deal to get the stalled bill moving.

Obama said in no uncertain terms that he supported the still-murky proposal crafted Tuesday night by Senate Democratic negotiators, "especially since it's aimed at increasing choice and competition and lowering cost."

No details were being released, but the deal appeared to solve one problem that's stymied progress: a split over whether to create a government-run health care plan, the so-called public option. Under the compromise, such a plan would be a backup, used only if insurers failed to meet certain standards. Instead, Medicare would expand and the federal government would oversee a new national, privately run insurance system.

Sen. Joe Lieberman, I-Conn., who had threatened to try to kill any plan that had a public option component, said he was encouraged by the latest news. Sens. Mary Landrieu, D-La., and Blanche Lincoln, D-Ark., also potential swing votes, expressed sympathy for aspects of the compromise while stopping short of endorsement, pending a cost assessment by the Congressional Budget Office.

Clearly, however, "the ball's moving forward," said John Fortier, a research fellow at Washington's American Enterprise Institute, a center-right research group.

The fate of the agreement rests with the nonpartisan budget office, whose report on its potential costs is expected in a few days.

"We certainly will await that, as well," White House Press Secretary Robert Gibbs said, indicating that even administration officials weren't sure precisely what the compromise would look like.

This much was apparent: A new government-run plan to compete with private insurers, an idea long sought by liberals and the White House, was barely alive. Instead, the federal Office of Personnel Management would oversee national insurance plans. Medicare, the government insurer of people older than 65, would be expanded so that certain 55- to 64-year-olds could sign on for coverage.

As Gibbs described the White House's general understanding of the Senate's vision, U.S. consumers could purchase the private plans through a federally managed menu. It would be akin to how U.S. government employees choose their insurance coverage.

Landrieu said the 10 moderates and liberals who had engaged in days of private talks on a compromise thought the new Medicare plan was "a good idea."

Lincoln said the government-supervised insurance idea "takes the best of both worlds. The government creates an environment where private industry can operate, but creates an environment in a way where the private industry is creating a product that meets the needs of the consumer."

At the same time, Lincoln cautioned, "There are a lot of things on the table, still."

Obama praised the Senate for making "critical progress (Tuesday) night with a creative new framework that I believe will help pave the way for final passage and a historic achievement on behalf of the American people."

Opponents on both ends of the spectrum pushed back.

"If the health care bill doesn't include a public option, it'll be a huge giveaway to the insurance companies," MoveOn.org, a liberal group, said in an e-mail to its members.

Rick Scott of Conservatives for Patients' Rights called the deal an "OPM plan," or "government-run health care with other people's money."

The health care overhaul bill that passed the House of Representatives includes a public option. If the Senate goes ahead without one, that difference will need to be hammered out before any health overhaul could be sent to Obama to become law.

Many insurance and medical interests had concerns about Medicare expansion.

"Any Medicare buy-in would invariably lead to (crowding) out of the private health-insurance market," the Federation of American Hospitals warned.

WASHINGTON – Senate Democrats, struggling to reach agreement on how to overhaul the country's health care system, got some practical political advice Tuesday from former President Bill Clinton, whose own effort collapsed 15 years ago.

Don't get too stubborn or demanding as you consider different pieces of the vast bill, he urged them at a closed-door Capitol meeting. Just pass something.

"It's not important to be perfect. It's important to move," Clinton said he told the senators. "The worst thing we can do is nothing. ... There is no perfect bill because there are always unintended consequences," he said, recalling his remarks after the meeting.

"So there'll be amendments to this effort, whatever they pass, next year and the year after that – and there should be. ... But the worst thing we can do is nothing. That was my argument," the former president said.

Clinton's pitch came as Senate Majority Leader Harry Reid, D-Nev., said he hoped the full Senate could begin considering a health care plan next week. Reid faces enormous hurdles, starting with simply getting the debate under way, since under Senate rules it will take 60 votes to cut off debate so the bill can be considered, and it's unclear whether Reid has those votes yet, even though Democrats control 60 of the 100 Senate seats.

Should the debate proceed, it still looks doubtful that Congress can meet President Barack Obama's goal of finishing health care legislation this year.

"I hope so, but count the days," said Sen. Richard Durbin, D-Ill., the assistant majority leader. "Our goal is to make sure it's out of the Senate this year."

The House of Representatives passed its version of the legislation Saturday. If the Senate passes its version, the two bills must be merged into one, and each chamber must pass that before Obama can sign it into law.

Democratic moderates have balked at several aspects of the legislation, including the government-run insurance plan, which would compete with private insurers. They also have concerns about the plan's overall cost and its impact on small businesses.

Clinton's appearance, suggested by Senate leaders and the White House, was seen as a way to calm them.

Two Democratic centrists, Blanche Lincoln and Mark Pryor, are from Clinton's home state of Arkansas. Another, Nebraska's Ben Nelson, was friendly with Clinton when both were governors in the early 1990s.

However, Clinton's appearance Tuesday didn't appear to sway anyone.

"At the end of the day, you make your own decision," Nelson said, adding that he's particularly worried about whether the legislation would hold down health costs.

Senate Democratic leaders are expected to offer a bill that includes a public option that states can opt out of, would bar insurers from denying coverage for pre-existing conditions and would tax high-end insurance plans.

Roundly criticized this summer for not meeting face to face with constituents over health care legislation, Rep. Doris Matsui, D-Sacramento, announced Tuesday that she will hold a public forum on health care, her first in-person town hall on the matter.

The session is scheduled from 11 a.m. to 12:30 p.m. Saturday at Sutter Middle School's multipurpose room, 3150 I St., Sacramento.

The debate over revamping the country's health care system is at a critical stage, as both the Senate and House finalize proposals to overhaul how health care is delivered.

Both sides in the debate have been marshaling supporters. President Barack Obama is looking to gain momentum and will be relying on supporters, such as Matsui, to serve as foot soldiers in his campaign to win passage of a comprehensive health care bill.

"For too many years, health insurance costs have grown faster than wages, and the number of Sacramentans without health insurance continues to climb," Matsui said in a prepared statement. "Saturday's forum will allow me to hear more from my constituents and answer their questions."

The congresswoman hosted two telephone town halls this summer, but was criticized by some opponents for not meeting with constituents face to face.

"It's a little too late," said Paul Smith, a Sacramento businessman and Republican vying to unseat Matsui for the 5th Congressional District. "I'm against the proposal in Congress to have a government-sponsored health care plan for the American people."

Smith said he plans to attend the town hall.

During the summer, most of the capital area's congressional delegation fanned out into their districts to hold town halls on health care. Discussions were lively and crowded.

Matsui's town hall on Saturday has a capacity for about 1,000, according to her staff.