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Democratic senator Lincoln feels pressure in health-care debate

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Although Pryor supports the reform effort, another prominent Arkansan, Rep. Mike Ross (D), voted against the House bill.

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"Most people support the need for health-insurance reform; they just think we can do it for less," Ross said. "They really, as I do, support more choices. They're just skeptical of a bill that takes 2,000 pages to accomplish that."

Ross was reluctant to offer Lincoln advice, but acknowledged her predicament. "She represents the whole state. I just represent one-fourth of the state. I'd just be guessing." But he added: "I think people fear the unintended consequences in a bill this massive."

Democratic leaders expect Lincoln to stick with them on key procedural votes, but are less confident about winning her support on critical amendments -- particularly on the contentious public option.

Lincoln's record on a government insurance plan has drawn detractors on both sides. In July, she wrote in the Arkansas Democrat-Gazette: "Individuals should be able to choose from a range of quality health insurance plans. Options should include private plans as well as a quality, affordable public plan or non-profit plan that can accomplish the same goals as those of a public plan."

By Sept. 1, she had changed her mind. "I would not support a solely government-funded public option," Lincoln said at an event in Little Rock. "We can't afford that."

In recent weeks, she also has raised concerns about both potential compromise approaches -- one that would allow states to "opt out" of a public plan that Senate Majority Leader Harry M. Reid (D-Nev.) is expected to include in the Senate bill, and a proposal by Snowe, the only Republican still at the negotiating table, to create a public option as a fallback if private insurers do not offer reasonable rates.

In the process, Lincoln has riled liberal groups including MoveOn.org, which is targeting her with radio ads, direct mail and rallies outside two of her Arkansas offices. Perhaps more ominously, MoveOn -- working with the liberal group Democracy for America -- has amassed $3.5 million in pledges to fund primary challenges against any Democratic senator who sides with Republicans to block an up-or-down vote on a bill with a public option.

"We think it's really important for her to see there are negative political consequences to being on the wrong side of this issue," said Ilyse Hogue, MoveOn's campaign director. "There's no arguing she's in a conservative state, but she's going to face a tough election no matter what, and she can't do it without the base. These are the activists, the people who knock on doors, and she is really running the risk of alienating them."

The National Republican Senatorial Committee is also documenting each of Lincoln's comments on health care to build a case against her. The Republican National Committee released a Web video this week that compares her public-option remarks to Sen. John F. Kerry's "I actually voted for it before I voted against it" line about Iraq war funding.

For GOP leaders, the best strategy for defeating the Senate bill is to sow doubts among vulnerable Democrats, convincing them that Reid is leading them off a political cliff.

"There's a great effort under way here to convince their members to ignore public opinion" on health-care reform, Minority Leader Mitch McConnell (R-Ky.) told reporters last week. "I hope it will not be lost on our Democratic friends where the public is, how the public feels about this measure. They're speaking increasingly loudly that they do not think it ought to pass."

Recent polls suggest that reform is a difficult sell in Lincoln's home state. The Arkansas Poll, conducted in mid-October by the University of Arkansas's Survey Research Center, found that 39 percent of voters support a public option and 48 percent oppose the idea. And respondents split about evenly on the question of whether reform would improve or hurt their quality of care.

"It's hard to draw firm conclusions," said Arkansas Poll Director Janine Parry. "People are dissatisfied, but they haven't signed on with an alternative." Lincoln, said Parry, appears to be "right with her constituents -- convinced that we need to do something, and not convinced it's this."

Senior Senate aides said Lincoln helped to shape measures aimed at reducing the cost of such procedures as MRIs and at better coordinating care among doctors, hospitals and nursing homes. And she was the primary sponsor, along with Snowe, of a provision aimed at giving small businesses more health-care choices for employees.

According to the Kaiser Family Foundation, of the nearly 473,000 Arkansas residents who lacked coverage as of 2008, virtually all would be eligible for federal assistance under the Senate bill -- either through Medicaid or through tax credits that would subsidize the purchase of private plans.

"There's a lot in the bill that will be good for Arkansas," Pryor said. "But there are a lot of people in our state who are against this bill. Some have very legitimate concerns and ask very good questions. But also some is based on bad information. We have to try to talk to those people."

If Lincoln supports the Senate bill, she will have to sell it to constituents before they see many of the legislation's benefits. But she says she is well aware of the challenge. "I have no doubt that I'll be held accountable on this," she said. "We're going to be held accountable on a lot of things."


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