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After Votes, Prospects for Public Health Insurance Option Dim in Senate

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President Barack Obama kept alive his hopes for a bipartisan health care bill as a U.S. Senate committee turned back an effort by liberals Tuesday to inject a government-run insurance plan into the legislation. (Sept. 29)

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By Shailagh Murray and Lori Montgomery
Washington Post Staff Writers
Wednesday, September 30, 2009

A key Senate panel twice beat back efforts Tuesday to create a government-run insurance plan, dealing a crippling blow to the hopes of liberals seeking to expand the federal role in health coverage as a cornerstone of reform.

In a signal moment in the increasingly fractious debate over reforming the nation's sprawling health-care system, Senate Finance Committee members rejected two amendments to create a public option on votes of 15 to 8 and 13 to 10.

Committee Chairman Max Baucus (Mont.) was one of three Democrats who voted no on both proposals. Baucus, who has emerged as the central player in shaping the bill, which is likely to be the main vehicle for debate on the Senate floor, said he supports the principle of a public option as an alternative to private insurance. But he warned that including it could doom the bill to a Republican filibuster.

"No one has been able to show me how we can count up to 60 votes with a public option," Baucus said. "I want a bill that can become law."

The votes are likely to deepen fissures in the Democratic Party over the shape of the legislation, and they proved what critics have long argued: Moderate Democrats are reluctant to expand the federal health-care role beyond the current boundaries of the Medicare, Medicaid and Department of Veterans Affairs programs. Even President Obama, who has repeatedly supported a government-run plan in public statements, has indicated that the idea is not worth the price of failing to enact his biggest domestic policy goal.

Despite the setback for advocates of a public option, debate over such a plan is certain to continue. Sens. John D. Rockefeller IV (D-W.Va.) and Charles E. Schumer (D-N.Y.), who offered the amendments that were voted down Tuesday, have vowed to keep the issue at the forefront as the debate unfolds. And Senate Majority Leader Harry M. Reid (D-Nev.) could include a government plan when he combines the Finance Committee's bill with Senate health committee legislation, approved in July, that includes a public option.

Aides said Tuesday that Reid has not decided how to proceed. If he doesn't include a public option, backers of a government plan will seek to amend the bill when it advances to the Senate floor, or during final negotiations with the House, where Speaker Nancy Pelosi (D-Calif.) remains a staunch advocate.

Supporters vowed to press on, expressing confidence that backing will grow as lawmakers consider the implications of relying on private insurers to bring about the far-reaching reform that many in Congress envision. Controlling the costs of health care is one of the primary goals of the push for change, and many Democrats believe that only the government has the clout to drive down premiums while ridding the system of costly inefficiencies.

"The public option is on the march," Rockefeller said, moments before his amendment was roundly defeated. Schumer pledged, "We are going to keep at this and at this and at this until we succeed, because we believe in it so strongly."

Finance Committee Republicans were united in their opposition. Sen. Charles E. Grassley (Iowa) called the public option a "slow walk toward government-controlled, single-payer health care."

House leaders hope to bring their reform proposal to the floor in October but are still debating how their public option would function. Under one version, rates paid to health-care providers would mirror Medicare payment rates, which are lower than those paid by private insurers for the same services. That would yield significant savings for beneficiaries through lower premiums, but it could wreak havoc on hospitals, doctors and other providers in rural communities, where the Medicare reimbursement rates are far below the national average.

Rockefeller's proposal also pegged public-plan rates to Medicare rates, drawing strong protests from committee Democrats who represent sparsely populated states. "Every hospital in my state goes broke" under the Rockefeller approach, said Sen. Kent Conrad, of North Dakota. "I can't possibly support an amendment that does that."


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