House Speaker Nancy Pelosi and other senior Democrats told President Barack Obama in recent meetings they want the legislation to strip the insurance industry of a long-standing exemption from federal antitrust laws, officials said. That provision is in the House-passed measure, but was omitted from the bill that the Senate passed on Christmas Eve. (Emphasis added)

They also want the final measure to include a House-passed proposal for a nationwide insurance exchange, to be regulated by the federal government, where consumers could shop for private coverage. The Senate bill calls for a state-based system of exchanges.

Additionally, House Democrats want to require insurers to spend a minimum amount of premium income on benefits, thereby limiting what is available for salaries, bonuses, advertising and other items. The House bill sets the floor at 85 percent; the Senate-passed measure lowers it to 80 percent for policies sold to small groups and individuals.

The officials spoke on condition of anonymity because the negotiations are private.

The maneuvering comes as the White House and majority Democrats intensify efforts to agree on a final measure, possibly before Obama delivers his State of the Union address late this month or early in February.

Government intervention into the insurance market is one of the most contentious issues to be settled. Others include the fate of a Senate-passed tax on high-cost insurance plans, bitterly opposed by some labor unions; the extent to which abortions could be covered by insurance to be sold in the new exchanges; and the amount of money available to help lower-income families purchase coverage.

Liberals long have pressed to include a government-run insurance option in the legislation, arguing it would create competition for private companies and place a brake on costs.

House Democrats included it in their legislation. In the Senate, it drew opposition from Democratic moderates whose votes are essential to the bill's fate. Even attempts to include an expansion of Medicare for uninsured individuals as young as age 55 — widely viewed as a face-saving proposal for liberals — had to be jettisoned.

Given the opposition in the Senate, Pelosi, D-Calif., signaled late last year she did not view a public option as a requirement for a final compromise. Asked in an interview Dec. 16 whether she could support legislation without it, she said, "It depends what else is in the bill."

More recently, she listed her goals for a House-Senate compromise without mentioning the provision she long has backed.