Senate health-care bill unlikely to include Medicare buy-in

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Tuesday, December 15, 2009

Senate Democratic leaders appeared poised Monday night to abandon efforts to create a government-run insurance safety net in their push for health-care reform, as they attempted to close ranks around a bill they hoped would win the backing of all 60 members of their caucus.

Democratic negotiators had already disappointed liberal lawmakers by jettisoning a full-fledged public insurance plan a week earlier. Last night, party leaders conceded that a key portion of the compromise they crafted to replace the public option -- a proposal allowing people as young as 55 to buy into Medicare -- also did not have sufficient support from Democratic moderates to overcome a likely Republican filibuster.

Senate Majority Leader Harry M. Reid (D-Nev.), after consulting with senior White House officials, rallied his caucus in a closed-door meeting Monday evening, reminding senators that there was broad consensus behind most of the provisions in the $848 billion package and warning them of the consequences of not passing a bill before the end of the year.

"Democrats are not going to let the American people down," he told reporters after the meeting. "I am confident that by next week, we will be on our way to final passage."

The full contents of the legislation probably will not be known until Tuesday, at the earliest, when the Congressional Budget Office is expected to provide an official cost analysis.

Senate Democrats will head to the White House on Tuesday afternoon to meet with President Obama. The Medicare buy-in proposal, announced last week by 10 moderate and liberal Democrats, was applauded by Obama as a worthy effort but received a cool reception from a small but crucial bloc of Democratic senators who have not committed to supporting the bill.

On Sunday afternoon, Sen. Joseph I. Lieberman (I-Conn.), whose vote is needed to break a GOP filibuster, appeared to deal the proposal a mortal blow when he told Reid he would not support any form of buy-in.

Reid and other Democratic leaders were furious with Lieberman, but his announcement forced a quick resolution to an issue that has clouded the health-care debate from the outset. Liberal lawmakers in both the House and the Senate have insisted on a public option as a way to force competition in marketplaces with few private insurers. But conservatives in both chambers are just as strongly opposed to the idea, seeing it as an unwarranted expansion of government that would squeeze private firms out of business and potentially leave taxpayers on the hook for the care of millions of people.

The Medicare buy-in proposal represented a drastically scaled-back version of the original public option and was envisioned as offering coverage to individuals between the ages of 55 and 64 who do not have access to employer benefits. Reid and senior White House officials were prepared to narrow the framework of the plan, essentially walling it off from the Medicare program while vastly reducing the pool of potential beneficiaries.

But even as the CBO was still examining the buy-in, Lieberman decided he could not accept it, and Reid was forced to face dropping it to prevent the bill from failing in its first procedural vote, which probably will occur later this week.

Although no final decision is expected until the CBO data are in hand, Democrats left a 90-minute emergency caucus meeting Monday night convinced of the proposal's demise. "It's looking like that's the case," said Senate Finance Chairman Max Baucus (Mont.). "It's just a matter of getting support from 60 senators."

Liberal senators took the news with surprising ease. "We've got to move it," the health committee's chairman, Tom Harkin (Iowa), a champion of the public option, said as he walked into the meeting. "There's good stuff in the bill. It's a giant step forward. We're changing the paradigm of health care in America."

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