Republicans have largely stuck with their plan to privatise the US Medicare health programme for the elderly – despite a rebuke in the Democratic-led Senate and a reversal in a New York special election.
Paul Ryan, Republican chairman of the House of Representatives budget committee and chief architect of the plan, said sweeping changes were needed in Medicare to protect it from financial ruin.
"We can no longer let politicians in Washington deny the danger to Medicare – the danger is all too real – and the health of our nation's seniors is far too important," Mr Ryan said.
On Tuesday, the Democrats won a vacant House seat in upstate New York, a traditional Republican stronghold, by turning the special election into a referendum on the plan to privatise Medicare.
The Republican proposal suffered another setback on Wednesday when the Democratic-controlled Senate blocked the measure on a vote of 57-40.
Five Republicans joined the Democrats in opposing it, but other Republicans ratcheted up efforts to build support for the plan, certain to be an issue in next year's congressional and presidential elections.
The proposal would end traditional fee-for-service Medicare and create a voucher-like system for future pensioners to buy medical cover from private insurers.Reuse content