Senate bill has public option

WASHINGTON - The Senate will consider in its health-care legislation whether the government should run and fund a plan to compete with private insurance, but states could choose not to participate in the public option.

Senate Majority Leader Harry Reid (D., Nev.) announced the compromise yesterday after nearly two weeks of closed-door negotiations with top White House officials and key senators. But it might not win enough votes to break Congress' deadlock over how to overhaul the health-care system.

Reid's bid to give states the power to opt out of the government plan aimed to win support from up to 12 moderate Senate Democrats and one Republican, Maine's Olympia J. Snowe, who have expressed reservations about a more sweeping, nationwide public option.

Snowe said she was "deeply disappointed" with the approach Reid had decided on.

Democrats control 60 of the Senate's 100 seats, and 60 votes are needed to overcome procedural hurdles in the chamber, so the defection of even one moderate could doom any plan. But reluctant moderates could vote with the Democratic leadership to overcome procedural blocks, then oppose the legislation on a final vote, which would allow it to pass with only a simple majority.

Sen. Tom Harkin (D., Iowa), chairman of the Health, Education, Labor and Pensions Committee, has estimated there are at least 52 Senate votes for a strong public option. The House, where Democrats hold a sizable majority, is seen as close to having the 218 votes it needs to pass one.

Reid would not say whether he thought he had 60 votes for any specific plan.

Democratic moderates were largely mum on his plan, but a few suggested there was room for compromise.

Sen. Mary Landrieu (D., La.) said she remained "very skeptical" of a public option, but "I look forward to reviewing the specific language" of the legislation and learning more about its cost.

Sen. Blanche Lincoln (D., Ark.), who faces a tough reelection campaign next year and said last week she had ruled out supporting a government-funded and -operated plan, said yesterday she would have to see the legislation's language and assess its impact on her state before she decided how to vote.

Another key centrist, Sen. Ben Nelson (D., Neb.), had no comment.

Reid said he chose the state opt-out compromise because "I believe there's a strong consensus to move forward in this direction." He plans to discuss the legislation this afternoon at a closed-door meeting of Democrats.

The opt-out provision is a compromise between lawmakers who want a government alternative and those who don't. Details of how it would work were still sketchy, but states would get a year after the 2013 phase-in of health-care legislation to decide whether to participate.

It is likely that once the Senate debate begins, probably in a week to 10 days, several variations of the public option will be debated and subject to votes.

Reid's announcement won instant applause from consumer groups and some unions and liberals, and drew the enthusiastic backing of the White House. Spokesman Robert Gibbs said President Obama was "pleased" at the development.

America's Health Insurance Plans, the industry trade group, was just as quick to criticize Reid's decision.

Karen Ignagni, the group's president, said: "A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality. The American people want health-care reform that will reduce costs, and this plan doesn't do that."

Republicans also voiced opposition.

"While final details of this bill are still unknown, here's what we do know," Senate Minority Leader Mitch McConnell of Kentucky said. "It will be a thousand-page, trillion-dollar bill that raises premiums, raises taxes, and slashes Medicare for our seniors to create new government spending programs."

Snowe has been unenthusiastic about a public option unless it comes with a "trigger," a provision that would create a government-run system in select markets only if the insurance industry failed to meet certain affordability standards in them.

Democratic negotiators discussed the trigger option over the last few days as a possible compromise, but Reid rejected it, saying the opt-out provision was "the fairest way to go."

Reid said he had talked to Snowe, and "at this stage she does not like a public option of any kind." But "we hope that Olympia will come back."

Reid said the Senate debate - which is expected to last for weeks - would begin as soon as the Congressional Budget Office completes a mandatory assessment of the bill's cost and impact on coverage.

Officials said Reid had prepared several variations of key provisions so he could make adjustments in his bill at the last minute and still make sure he was within Obama's target of a $900 billion price tag over a decade.

Both the House and Senate are struggling to complete work by year's end on legislation extending coverage to millions who lack it, to ban industry practices such as denying coverage because of preexisting medical conditions, and to slow the rise in medical costs nationally.

Differences in bills passed by the two chambers must be reconciled before any legislation reaches Obama's desk.

Some details of a provision, to be included in the Senate bill, for the government to sell health insurance in competition with the private market:

Sen. Charles E. Schumer (D., N.Y.), who came up with the idea, proposed requiring that states

pass laws to exit the public plan.

- Associated Press

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