Public option at center of debate
Reid must find compromise to pass health-care bill

By Shailagh Murray
Washington Post Staff Writer
Monday, November 23, 2009

Democrats had little time to savor their weekend Senate health-care victory, as two of the lawmakers who voted to move the debate forward Saturday night indicated Sunday that they will not vote to pass the package if it includes a government-run insurance program.

Despite the success in the test vote, the fragile consensus in the Democratic caucus will face its greatest test yet as the health-care debate moves to the Senate floor and Majority Leader Harry M. Reid (Nev.) struggles to stave off internal schisms. The cracks in the 60-member caucus are most obvious over the public insurance option.

One member of the Democratic caucus, independent Sen. Joseph I. Lieberman (Conn.), reiterated Sunday that he will oppose any bill that contains a public option. Appearing on NBC's "Meet the Press," he called such a government-run plan "radical."

"We have a health-care system that has real troubles, but we have an economic system that is in real crisis," Lieberman said. "And I don't want to fix the problems in our health-care system in a way that creates more of an economic crisis."

Sen. Ben Nelson (D-Neb.), another centrist who supported the move to continue debate but has made it clear he has many objections to the legislation as currently written, restated his opposition to a public plan. "I don't want a big-government, Washington-run operation that undermines the private insurance that 200 million Americans now have," he said on ABC's "This Week."

Moderate Democratic Sens. Mary Landrieu (La.) and Blanche Lincoln (Ark.) also have deep misgivings about the Senate language -- a public option with a state opt-out clause -- and have expressed varying degrees of unhappiness about other approaches under consideration.

Some liberals in the chamber were just as insistent that they will press to keep the bill largely intact. "I don't want four Democratic senators dictating to the other 56 of us and to the rest of the country -- when the public option has this much support -- that [a public option is] not going to be in it," Sen. Sherrod Brown (Ohio) said on CNN's "State of the Union."

Reid announced after the vote that the Senate will begin deliberations on the $848 billion bill Nov. 30 and will consider amendments through most of December. What Democrats lack in consensus they make up for in determination to pass a bill. Not for years has the Senate seen legislation as big as the health-care measure -- weighing in at more than 2,000 pages -- move forward at such a steady, if plodding, pace. "We know not all 60 senators in my caucus agree on every aspect of this bill," Reid told reporters after the vote. "But all Democrats do believe now is the time to make sure all Americans can access affordable health insurance."

And the deadline pressure is mounting. With less than a year until the 2010 midterm elections -- and with Reid himself facing a potentially tough race at home in Nevada -- senators are eager to vote on health care before Christmas and complete negotiations with the House no later than the end of January, so they can turn their attention to legislation aimed at creating jobs.

"We have to finish it in the Senate or it's going to be maybe a long lunch break over Christmas," Majority Whip Richard J. Durbin (Ill.) said on "Meet the Press," suggesting that lawmakers may be forced to cut into their holiday recess to work on the bill. "We've got to really focus, refocus our attention -- all of our attention on getting people back to work."

Durbin argued for the public option but indicated a willingness to compromise to pass the measure.

For every member of the Democratic caucus Reid loses, he must gain the support of a Republican, and at the moment the number of potential converts adds up to no more than two. Maine moderates Olympia J. Snowe and Susan Collins are probably the only GOP senators Reid has any hope of attracting to the 60-vote bloc necessary to head off a filibuster.

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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