(AP Photo/Alex Brandon)

DAVID ESPO, AP Special Correspondent

WASHINGTON (AP) — President Barack Obama, insistent that health care legislation will still clear Congress, urged lawmakers strongly on Friday to write stiffer cost-cutting provisions into the bills taking shape slowly in the House and Senate.

“What we want to do is force the Congress to make sure that they are acting” on recommendations lawmakers receive to hold down Medicare and Medicaid spending, the president said, rather than allowing reports to sit unused on a shelf.

He spoke from the White House, near the end of a week of tumult for the legislation atop his domestic agenda.

“Now is certainly not the time to lose heart,” he declared.

A few hours earlier, two House committees approved their portions of the sweeping health care bill over Republican objections.

That left one more panel to act, but conservative Democrats were rebelling, demanding additional measures to hold down skyrocketing costs.

Given the complexities, as well as fresh calls for delay in the Senate, House Speaker Nancy Pelosi, D-Calif., opened the door to pushing off a vote past the early August timeline she and Obama laid out weeks ago.

Whatever the difficulties, she predicted legislation would pass that will transform the nation’s health care system, extending coverage to millions who lack it while slowing the growth in costs generally. “It is really historic. It’s transformation. It’s momentous,” she told reporters at a news conference.

If anything, Obama tried to project even more confidence.

Ticking off a list of accomplishments to date, he said, “We are going to get this done. We will reform health care. it will happen this year. I’m absolutely convinced of that.”

Without the overhaul, he said, “no one’s health insurance is going to be secure, because you’re going to continue to see premiums going up at astronomical rates.”

Obama’s call for additional steps to hold down costs came one day after the head of the Congressional Budget Office told Congress the legislation taking shape so far would fail to accomplish that.

Those remarks by Douglas Elmendorf produced fresh criticism from Republicans, and gave pause to Democrats, as well.

In letters to Pelosi as well as key committee chairman, administration budget director Peter Orszag called for additional steps to ensure the bill “rewards quality, restrains unnecessary costs and provides better care to more Americans.”

Legislation is already pending in the Senate to reduce the control individual lawmakers and Congress as a whole have over setting the rates doctors and other providers are paid under Medicare. In his letter, Orszag forwarded an alternative proposal that he said would accomplish the same goal.

“We’re very proud of the savings (already in the legislation)” Pelosi told reporters, although she added, “Of course, we want more.”

Under current law, a Medicare Payment Advisory Commission makes recommendations to lawmakers annually on the rates Medicare pays doctors and other health care providers. Lawmakers are not obliged to follow them, or even vote on them.

Obama recommended changing that, requiring lawmakers to vote on the recommendations and proposing they take effect unless rejected by the House and Senate.

In a statement released after Obama spoke, Senate Majority Leader Harry Reid said lawmakers “now stand on the doorstep” of enacting legislation.

For her part, Pelosi signaled that she, too, was open to additional cost-cutting provisions and suggested they may be incorporated into the bill next week by the House Energy and Commerce Committee.

Any legislation that emerges from Congress is expected to require insurance companies to issue policies to anyone who seeks coverage, without turning them down or charging higher premiums on the basis of pre-existing medical conditions.

To spread insurance more widely, both the House bill and companion proposals in the Senate would rely on hundreds of billions of dollars in federal subsidies to assist lower income families. The House bill also calls for the government to sell insurance in competition with private industry, a provision that Republicans in particular oppose strongly.

While Pelosi has long said the House will vote on legislation by the time lawmakers leave on vacation at the end of July, she hedged for the first time at the news conference.

“We have to see what the Senate will do,” she said, before suggesting that changing the bill to produce more savings might require additional time.

For now, she emphasized, “we are on our schedule to bring up legislation before the break and we continue to be on that schedule.”

She spoke not long after six senators, three Democrats, one independent and two Republicans, announced their opposition to “timelines which prevent us from achieving the best result.”

“We believe that taking additional time to achieve a bipartisan result is critical,” they said in a letter to the Senate leaders of both parties.

The letter was signed by Democratic Sens. Ben Nelson of Nebraska, Ron Wyden of Oregon and Mary Landrieu of Louisiana, as well as Maine Republican Sens. Susan Collins and Olympia Snowe and independent Sen. Joe Lieberman of Connecticut.

Snowe has been deeply involved in talks in recent days aimed at drafting bipartisan legislation.

Those talks have been led by Sen. Max Baucus, D-Mont., the chairman of the Senate Finance Committee, but they recessed on Thursday for the weekend without any indication that an agreement is at hand.

Reid, like Pelosi, has said he wants legislation on the Senate floor before lawmakers go home for the summer.

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Associated Press Writers Erica Werner, Chuck Babington, Ricardo Alonso-Zaldivar and Stephen Ohlemacher contributed to this story.

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