washingtonpost.com
White House aides reaffirm public option is not mandatory
Interest groups step up advertising campaign as health-care vote nears

By Ceci Connolly
Monday, October 19, 2009

The television airwaves were filled Sunday with rat-a-tat over reforming the nation's health-care system, as top administration officials hit the talk show circuit and interest groups waged a record advertising blitz.

President Obama's team, preparing for an intense round of private negotiations on Capitol Hill, used public appearances to set the parameters for the negotiations.

Obama continues to support the concept of a government-sponsored insurance option, but "he is not demanding that it is in" the final legislation, Valerie Jarrett, a senior White House adviser, said on NBC's "Meet the Press." "He thinks it's the best possible choice."

White House Chief of Staff Rahm Emanuel, in two television appearances, noted that the public option could provide much-needed competition, but that "it's not the defining piece of health care."

Liberal lawmakers such as Sen. Christopher J. Dodd (D-Conn.), who is involved in the negotiations, said they will push for the government option to be included in the bill that goes to the Senate floor. "I haven't given up on this," Dodd said on NBC.

Advocacy groups also pressed the case in television and print ads. In one spot airing on several networks, the liberal coalition Health Care for America Now calls out "huge insurance companies driving prices up."

"We need real competition to lower costs," the commercial concludes. "We need the choice of a public health insurance option."

Obama aides conceded that they may not have the votes in the Senate for the provision.

"There are people in the Senate -- Republicans and Democrats -- who have objections to that," senior White House adviser David Axelrod said on ABC's "This Week."

The notion of a public insurance alternative has divided Democrats for months. It remains a major sticking point, though it would affect only the fraction of Americans who work in small businesses or buy coverage on their own.

Proponents argue that a nonprofit plan with lower administrative fees and executive salaries could provide more-affordable coverage. Industry leaders and some lawmakers in both parties fear it would lead to a government-run health system and would force private companies out of business.

As Obama has inched closer to enacting his top legislative priority, his allies and the insurance industry have grown increasingly hostile. Administration aides lambasted the industry after it released two reports last week that said private insurance premiums would probably increase under the bills circulating in Congress.

"Most of the stakeholders in this health-care debate are at the table; they're trying to produce real reform," Axelrod said. "The insurance industry has decided now at the eleventh hour that they don't want to go along with this. One of the problems we have is we have a health-care system now that functions very well for the insurance industry but not well for the customers."

Asked whether Obama has been "tough enough" in his first year in office, Axelrod replied: "The president in his radio address took on the insurance industry, at least rhetorically, and he suggested that he might be willing to take away their antitrust exemption."

The health-care battle will be tested this week in the Senate, as Democrats push a bill that would set aside nearly $250 billion over the next decade for higher Medicare payments to physicians. The reimbursement rates are scheduled for automatic reductions. But each year, Congress overrides the formula, which would trim fees by 21 percent in 2010.

Fixing the payment gap is of enormous concern to the American Medical Association, but lawmakers have yet to find the money to pay for it.

Obama and Senate Finance Committee Chairman Max Baucus (D-Mont.) kept the provision out of health-care reform legislation, saying it is something Congress would do regardless of broader reform. But Republicans and some Democratic deficit hawks object.

"This is so transparent," said Senate Minority Leader Mitch McConnell (R-Ky.). "They're taking this issue out of health care, suggesting that we spend a quarter of a trillion dollars, not pay for it, so that they can then argue, the very next week potentially, that this trillion-dollar health-care bill is paid for."

In between the talk show chatter, the AMA weighed in with an ad.

"For seniors, a doctor can mean everything -- independence, hope, security -- and Medicare makes it possible," the narrator says. "We need a permanent solution to protect Medicare and ensure seniors get the security and stability they've earned."

View all comments that have been posted about this article.

© 2009 The Washington Post Company