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Public option at center of debate

Sens. Richard J. Durbin (Ill.), left, and Joseph I. Lieberman (I-Conn.) appear on NBC's
Sens. Richard J. Durbin (Ill.), left, and Joseph I. Lieberman (I-Conn.) appear on NBC's "Meet the Press." Lieberman said he would part with Durbin and others in the Democratic caucus over the public option. (William B. Plowman/associated Press)
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Polls show that a public option -- essentially a government-sponsored insurance plan that would be offered alongside private policies on exchanges created for people who do not have access to affordable employer coverage -- remains popular with voters, although less so in more conservative states. But according to the Congressional Budget Office, a government plan as outlined in both the Senate and House bills would cost more than private coverage and, as a result, attract few customers.

The question is whether Reid and the many Democratic senators who are working to resolve the issue can identify an acceptable compromise. If not, some of Reid's Democratic colleagues think the only way liberals will relent is if he calls a vote on a Senate bill with a public option and the legislation fails.

Given the concessions that Reid offered to Landrieu, Lincoln and Nelson to secure their votes on Saturday, including a $300 million Medicaid provision for Landrieu's home state of Louisiana, liberal senators are fully aware that the public option is vulnerable.

But other flash points also have emerged. One that surfaced last week, and could cause political indigestion for Democrats from conservative states, involves provisions in the Senate bill that the gun-ownership lobby has identified as potentially problematic.

The conservative group Gun Owners of America sent out an action alert to its 300,000 members on Friday warning that the Senate legislation would mandate that doctors provide "gun-related health data" to "a government database," including information on mental-health issues detected in patients, which could jeopardize their ability to obtain a firearms license.

In addition, the group said the legislation's "wellness" provisions -- designed to encourage more healthful lifestyles -- would allow federal officials to mandate that companies charge higher insurance premiums for employees who own guns.

Also unresolved in the Democratic caucus is the degree to which employers should be required to provide coverage. Nelson, like Republican Snowe, has said he will seek to modify the Senate bill to ease the financial burden on small businesses.

But liberal senators want the Senate measure to impose tougher rules for companies. Sen. John F. Kerry (D-Mass.), a proponent of a robust employer mandate similar to the one in the House bill, is weighing whether to offer an amendment that would toughen the Senate legislation by adding fines for uncovered part-time workers and by lowering the threshold for penalties to firms with as few as 25 workers.

And while Reid is managing Democratic skirmishes, Republicans are expected to offer their own series of provocative amendments, including measures related to abortion and illegal immigration intended to underscore the GOP's argument that Democrats are orchestrating a government takeover of the health-care system.

"The important thing is for the American people to understand that this bill doesn't fix what's wrong with health care," Sen. Tom Coburn (R-Okla.), a physician who is expected to play a prominent role in the floor debate, said on ABC's "This Week." "We're treating symptoms, not the disease."

Staff writers Paul Kane and Lori Montgomery contributed to this report.

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