Senate health bill unlikely to include Medicare buy-in
Insufficient support for public-option alternative

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."

Sen. Sherrod Brown (D-Ohio), another champion of the public option, told reporters: "I want to see health-care reform. There's going to be a good bill."

Sen. John D. Rockefeller IV (D-W.Va.), the lead liberal negotiator of the buy-in deal, said he was willing to drop the measure, for the sake of moving the bill forward. "We're not going to get all that we want," he said. "But we're going to get so much more than we have."

Monday night's meeting was unusually long for the Senate, and it featured numerous speeches. One passionate endorsement of the bill came from Sen. Arlen Specter (D-Pa.), who switched parties earlier this year. Specter urged his Democratic colleagues, "Don't let those obstructionists win," one participant recalled.

The room erupted in applause when Specter reminded the group, "I came to this caucus to be your 60th vote." But soon after the speech, Sen. Ben Nelson (D-Neb.) left the session early, telling reporters he remained undecided.

Democrats said they were confident that their colleagues would overcome lingering concerns. "To use an old cliche, the general consensus was we shouldn't make the perfect the enemy of the good," Sen. Evan Bayh (Ind.) said as he left the meeting.

Late Monday, Reid sought to settle other unresolved issues that are preventing the bill from moving forward. He spent much of the afternoon trying to satisfy Nelson's concerns about abortion coverage, said Reid spokesman Jim Manley. That effort is expected to continue Tuesday.

Under pressure from AARP, an influential lobby for retirees, Senate leaders also agreed Monday to close the annual gap in Medicare prescription drug coverage known as the "doughnut hole." The gap leaves beneficiaries to pay for their own medicine after they have received $2,700 worth of covered drugs. Coverage picks up again when drug costs hit $6,100, but few seniors make it through the hole to the other side.

The bill approved by the House on Nov. 7 would close that gap, but the more cost-conscious Senate had offered only to narrow the gap temporarily by $500 in 2010. Speaking on the Senate floor late Monday, Reid and the two primary sponsors of the legislation -- Baucus and Sen. Christopher J. Dodd (D-Conn.) -- lamented the plight of seniors who are unable to afford medicine and vowed to include provisions to close the doughnut hole in final negotiations with the House.

"We have already taken the first steps to fix this in the current bill, closing the gap by half and by an additional $500 for 2010. Because I am committed to saving lives, saving money and saving Medicare, I am committed to fully closing it, once and for all," Reid said. "The legislation we will send to President Obama for his signature will make good on his promise and ours to forever end this indefensible injustice for America's seniors."

Closing the gap was AARP's top priority in the Senate, and the group had signaled that it could withdraw its tentative support for the bill without that change. In a letter to Reid late Monday, AARP chief executive A. Barry Rand thanked Senate leaders for their commitment to solve the problem and offered his endorsement of the bill.

"We understand, given Senate constraints, that this action must wait until conference," Rand wrote. "With your commitment to closing the doughnut hole in conference, consistent with the President's pledge . . . AARP is pleased to support your efforts to obtain cloture, and urges timely passage of this legislation by the Senate."

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