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Prognosis improves for public insurance

Noncommittal response

The Democratic leader pitched the opt-out idea to Obama at a White House meeting Thursday night and received a noncommittal response. Several senior Democratic sources said Obama is wary about alienating Snowe -- the only Republican so far to support a Democratic health-care measure -- and had already concluded that her plan for a "trigger" that would create a public option if private insurers don't offer affordable rates represented a satisfactory compromise.

Reid's original inclination was to leave the public option out of a final bill he is writing from measures passed by the finance and health committees. But his liberal colleagues began urging him two weeks ago to reconsider, after insurance industry forecasts that premiums would rise sharply under the Finance Committee bill, which lacked a public option. The report had the effect of prodding Democrats to look for better ways to control costs, and the public option -- strongly opposed by the insurance industry -- reemerged as a possible solution.

Because a government-run plan would be dedicated to holding down costs and would lack a profit motive, congressional budget analysts predict that it could reduce the cost of expanding coverage to people who don't have it by as much as $100 billion over the next decade.

In the House, Pelosi was still trying to line up votes for the most cost-effective version of the public plan, one that would pay providers based on Medicare rates. Rank-and-file House Democrats summoned Friday to an early-morning caucus were asked to say publicly whether they would vote for a bill that included such a provision.

Muddying the waters

Senior Democrats said it was still unclear whether that idea would prevail. While support for a "robust" public option is strong, they said, other issues are muddying the waters. For example, as many as 20 votes hinge on resolving a battle over abortion that has pitted an unyielding abortion-rights faction against antiabortion Democrats who want to make sure no federal money is used to pay for the procedure.

House leaders planned to work through the weekend to resolve as many individual concerns as possible, with the goal of producing a bill as soon as next week.

As part of that painstaking lobbying effort, Pelosi told reporters that she may have to resort to a version of the public plan that would allow providers to negotiate rates, presumably resulting in more generous payments. In the Senate, a plan that ties rates to Medicare is a nonstarter.

Both Pelosi and Clyburn said they would be open to the Senate's opt-out approach. "I don't think there's much problem with that," Pelosi said. Clyburn added: "All they're debating is whether or not to allow states to opt out of it, but you'll still have the same public option."

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