Senate moderates wield influence to seek changes to health-care reform

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Wednesday, November 4, 2009

Moderate lawmakers are exerting their outsize influence in the divided Senate to secure changes to health-care reform legislation, potentially adding more delays to a bill that has already missed several announced deadlines.

Although they have yet to achieve the "gang" status accorded to previous centrist coalitions, a dozen or so moderate Democrats are emerging as pivotal to the fate of the health-care measure -- beginning with the procedural vote that Senate Majority Leader Harry M. Reid (D-Nev.) must win to launch the historic debate.

Moderates have raised numerous concerns about aspects of the bill, including the public insurance option that liberals persuaded Reid to add last week. Although Reid included an "opt out" provision for states that don't want to participate, many moderate Democrats prefer a "trigger" mechanism, proposed by their lone Republican ally, Sen. Olympia J. Snowe (Maine). Her approach would allow government-backed coverage only in states where private insurers fail to offer broadly affordable plans.

The list of complaints stretches on: Some senators, including Mary Landrieu (D-La.), want to do more to protect small businesses. Sen. Evan Bayh (D-Ind.) has sought to shield the medical-device manufacturers in his state from hefty fees. Sen. Ben Nelson (D-Neb.) dislikes provisions that would lift federal antitrust protections for insurance companies and would create a new government insurance program for long-term care.

Resolving such disputes could take weeks, making it increasingly unlikely that President Obama will meet his goal of signing a health-care bill by Christmas. Instead, Democrats are now pointing to the date of the State of the Union address as a more realistic target. "We're not going to be bound by any timelines," Reid told reporters Tuesday. "We're going to do this legislation as expeditiously as we can, but we're going to do it as fairly as we can."

Later in the day, Reid spokesman Jim Manley sought to clarify that the Christmas deadline is still attainable. "Our goals remain unchanged. We want to get health insurance reform done this year, and we have unprecedented momentum to achieve that," Manley said.

Reid is working behind the scenes to lock down 60 votes against a Republican filibuster aimed at preventing the bill from reaching the floor. Senate aides said he has received commitments from all but three Democrats: Nelson, Landrieu and Sen. Blanche Lincoln (Ark.), who met with Obama on Tuesday to discuss the bill.

Some Democratic leaders have urged moderates to begin plotting an amendment strategy for the Senate floor, partly to expedite the debate but also to maximize their considerable clout.

Landrieu said she is working with Snowe to build support for the trigger alternative. The opt-out provision, which was offered by liberals as a compromise, has come under scrutiny because of the likelihood that conservative Southern and Western states with large uninsured populations would decline to participate in a government-run insurance plan.

A trigger would have the opposite effect, automatically creating a public option in states where private competition did not make insurance affordable. Obama has praised the idea as a potential compromise.

"What we have to move forward thinking about is, as the president has said, people keeping what they have if they like it, having more choices, reforming the private market," Landrieu said. "And if we can achieve that through private-sector reform, that's wonderful. And if not, then there should be a mechanism that basically, I guess, guarantees it, which would be a well-crafted trigger."

Moderates have already beaten back a mandate on employers to provide insurance coverage, although liberals are expected to offer amendments on the floor that would impose such a requirement. Moderates are also focused on making coverage more affordable for individuals and on keeping the overall cost of the package low -- issues that are in conflict, because the more the bill spends to make policies cheaper, the higher its price tag is likely to be.

Reid's toughest convert could be Nelson, a conservative former insurance executive who has raised numerous concerns about the Senate legislation and who is not ready to agree to let the debate begin.

"Obviously, from my standpoint, I'd rather see the final product up front, rather than have to go through the process to establish what the final product is," Nelson said.

Although Snowe is expected to vote with Republicans on the initial filibuster, to register her opposition to the opt-out clause, she said she would join forces with Democratic centrists to shape a bill that could pass. "I'm working with them in any way that I can," she said.

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