Liberals increase pressure for public insurance plan in health bill
Combined bill could be introduced this week

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Wednesday, October 21, 2009

Senate Majority Leader Harry M. Reid is facing intensifying pressure from liberal lawmakers to revive a proposed government insurance plan before health-care reform legislation reaches the Senate floor, amid signs that moderate Democrats may be warming to the idea.

Two versions of the "public option" were rejected by the Senate Finance Committee as potentially too great a threat to the insurance industry and the coverage it provides to millions of families and individuals. But the idea has gained momentum in recent weeks as Democrats look to ensure that the policies Americans would be required to buy would be affordable.

A small team of Senate negotiators, led by Reid (D-Nev.), is crafting a blueprint for reform that combines the finance panel's legislation with a more liberal Senate health committee bill that includes a government plan. The House measure, now under negotiation in that chamber, also includes a public option.

On Tuesday night, in a closed-door session with rank-and-file Democrats, House Speaker Nancy Pelosi (Calif.) said she is close to counting 218 votes for a public plan linked to Medicare rates, the version preferred by liberals in both chambers, according to Democrats attending the meeting. But Pelosi said a final decision will not be made until Democrats meet again Wednesday. New estimates show that the House could construct a package with a "robust" public option for about $871 billion over the next decade, according to a Democratic source.

Senate liberals are seeking to convince Reid that the public option has more support than the Finance Committee's votes suggested. And as the majority leader prepares to release a combined bill as soon as Friday, he is canvassing moderate Democrats to determine how much leeway he may have.

Sen. Kent Conrad (D-N.D.), a senior member of the finance panel, was so opposed to a public option during deliberations that he devised an alternative coverage model, a network of nonprofit cooperatives that ended up in the committee's bill. Conrad said the public option many liberals want is a non-starter, because it would align its reimbursement rates with Medicare's. Because the Medicare rates his state pays are among the country's lowest, such a plan would drive hospitals there out of business, he said.

But Conrad said other approaches -- including a public option with rates negotiated directly with health-care providers, as is done by private insurers -- could pass. "I can see the potential for a compromise," he said.

Sen. Ben Nelson (D-Neb.) has discussed various provisions with Reid this week, including the public option. He said a mechanism that would create a public option if private insurers do not offer affordable coverage "is not a deal-killer." And Nelson said he is intrigued by an approach advocated by Sen. Charles E. Schumer (D-N.Y.) that would let states opt out of a public plan.

"There's a balance here that has to be created, and the leader, I know, is doing his level best to find that balance," Nelson said.

For Reid, the challenge is finding middle ground that accommodates moderates such as Conrad and Nelson and Sen. Olympia J. Snowe (Maine) -- the only Republican to vote for the finance panel's bill -- but that also assuages his colleagues on the left, some of whom have threatened to vote against a measure that does not contain a public option.

Sen. Benjamin L. Cardin (D-Md.), a strong supporter of a public option, said his conversations with Reid suggest that "he is trying to figure out a way that he can bring that forward without jeopardizing the ability of getting the necessary votes for this bill."

Reid told reporters Tuesday that talks are ongoing. "I've had a number of meetings in my office dealing with Democrats and Republicans on the public option," he said. When the negotiations conclude in the coming days, "I will have made a decision as to what we're going to do with the public option. It's not done yet."

Meanwhile, Senate Democrats were still trying to rally support to end scheduled pay cuts for doctors who serve Medicare patients. Since 1997, doctors have faced the prospect of having the payments cut to match inflation under the sustainable growth rate. In January, that formula would require the payments to be cut by more than 21 percent.

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