A delegation of senior White House officials met on Wednesday at the Capitol with the Senate majority leader, Harry Reid of Nevada, and the chairmen of the Finance and health committees, as Democrats turned their full attention to merging competing versions of the comprehensive health care legislation.
The effort to combine the two bills is complicated and, politically, a potentially treacherous task. The Democrats must negotiate sharp disagreements between the liberal and centrist members of their party while also trying to hold the support of Senator Olympia J. Snowe of Maine, the one Republican so far to support the legislation.
At the same time, Democrats in the Senate and the House moved to address a problem that has bedeviled Congress for years: how to avoid cuts in Medicare payments to doctors that are set to occur automatically. The cuts pose an obstacle to the larger health care bill because preventing them could cost more than $200 billion over 10 years.
The White House team, arriving at the Capitol barely 24 hours after the Finance Committee approved its bill on Tuesday, was led by the chief of staff, Rahm Emanuel, and included the budget director, Peter R. Orszag; the health and human services secretary, Kathleen Sebelius; and the health care policy coordinator, Nancy-Ann DeParle.
Senate Republicans have warned in recent days that Democratic leaders could make changes to the legislation before it reaches the floor. Senator Orrin G. Hatch, Republican of Utah, for instance, said the bill was “being written behind closed doors in the dark corners of the Capitol and the White House.”
The Congressional leaders and the White House officials gathered around a conference table in a meeting room that most recently had been the Capitol hideaway of Senator Edward M. Kennedy of Massachusetts, who died of brain cancer in August.
Mr. Hatch was right about the closed doors, and about the corners, but it was not dark. The spacious corner office overlooks the Mall and, thanks to its large windows, is well-lighted.
Mr. Reid sat at the head, flanked by the finance chairman, Max Baucus, Democrat of Montana, and Christopher J. Dodd, Democrat of Connecticut, who was the acting chairman of the health committee in Mr. Kennedy’s absence.
Mr. Reid, whose political future could hinge on his skill in merging the two bills — he is up for re-election next year — said at a news conference that President Obama would also have a hand in shaping the final measure.
“All four of us are legislators,” he said, referring to Mr. Baucus, Mr. Dodd, and Mr. Emanuel, a former representative from Illinois. “All four of us understand that legislation’s the art of compromise, consensus-building. And we’re going to do that.”
Mr. Reid added: “I’m not going to get into a lot of details. I’m not going to negotiate out here. But it’s fair to say that this is why we were elected. This is legislating at its best.”
Participants said the discussion focused broadly on issues like whether to create a government-run insurance plan and whether to provide more generous subsidies to help people buy insurance. “The conversations are just starting,” Ms. Sebelius said as she left the session. “People are eager to keep the momentum going.”
Another official who was in the room called the meeting an “initial clearing of the air” and said that Mr. Emanuel had pointed to a new report, projecting a 10 percent increase in employee health benefit costs, as evidence that the existing health system was unsustainable even for Americans who have insurance.
The work of merging the Senate bills came as House Democratic leaders said that they would probably not vote on their version of the health care legislation until mid-November.
While making steady progress through the year, both chambers have repeatedly missed self-imposed deadlines.
Mr. Hoyer and the House speaker, Nancy Pelosi, are working with party leaders to merge three versions of the legislation into a single measure.
The House legislation includes a $228.5 billion provision to avert cuts in Medicare payments to doctors and permanently replace the payment formula to provide annual increases. The Senate Finance Committee bill provides $10.9 billion to avert the cuts for one year.
Lobbyists for the American Medical Association and other physician groups met with Senate Democratic leaders on Wednesday to discuss a long-term fix. Under current law, doctors face cuts of 21.5 percent in January and about 5.5 percent in each of the next four years.
On Tuesday, Senator Debbie Stabenow, Democrat of Michigan, introduced a bill to block the cuts and eliminate the existing formula, which defines a “sustainable growth rate” for Medicare spending on doctors. Senate Democrats said they might try to take the bill directly to the floor next week.
On this issue, Mr. Hoyer said, “There is a difference between the Senate and the House, and it is a pretty substantial difference.”
Asked whether the House would offset the cost of its proposal, he said, “I don’t think we are going to pay for it.”
Many doctors support Mr. Obama’s effort to pass sweeping health legislation this year. But they have also been spent countless hours trying to abolish the Medicare formula that threatens to cut their fees each year.