(Pelosi: Bill will have a Public Option. NBC’s Andrea Mitchell talks with House Speaker Nancy Pelosi about the inclusion of a public option in the House health care reform bill. Watch the entire interview on Friday.)
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(Measuring the worth of a Public Option. House Majority Leader Rep. Steny Hoyer discusses whether a public option is a necessity that is worth the cost in political capital.)
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(Cloture could save the Public Option)
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Senate bill may have Public Insurance plan
Democratic leaders in Congress pressed their rank-and-file to allow the government to sell health insurance in competition with private industry as they struggled to pull together a comprehensive health care bill that meets President Barack Obama's goals.
The Senate has long been seen as opposed to the government selling insurance in competition with insurers, but now senior Senate Democrats and White House officials are strongly considering including such a measure, officials say. The provision would permit individual states to drop out of the system, a design that could make it more palatable to moderates who have opposed the "Public Option."
Liberals in Congress view a public option as a critical ingredient to an overhaul of the nation's health care system, and Obama has said frequently he favors it. But he has also made clear it is not essential to the legislation he seeks, a gesture to Democratic moderates who have opposed it.
Sens. Ben Nelson, D-Neb., and Kent Conrad, D-N.D., said in separate interviews that they had been told the plan was drawing interest in private negotiations led by Senate Majority Leader Harry Reid, D-Nev., who is merging health bills passed by two separate committees into a final package to bring to the floor.
"What I'm hearing is that this is the direction of the conversation," said Conrad, who supports an alternative approach under which nonprofit co-ops would compete with private industry.
Nelson said he'd also heard the plan was drawing favor, adding he thought that was unfortunate.
The White House declined to comment. Reid's office did likewise, and the Nevada Democrat left a meeting at the White House with other Democrats late Thursday without talking to reporters.
But according to The New York Times, which quoted a Democratic aide, Reid informed the president of his inclination to add the public option to the bill Thursday, but did not specifically ask him to endorse the approach. Reid is reportedly calculating whether his caucus would support the legislation if there was a way for states to opt out of the government plan.
Several officials said no final decisions had been made, with one possibility that the idea was being circulated to see whether it could attract enough support to survive on the Senate floor.
If not, it surely would be jettisoned beforehand, with liberals urged to accept something less or risk defeat of health care legislation. There is little margin for error among Obama's allies in the Senate as they confront nearly unanimous Republican opposition.
Legislation taking shape in the House is also expected to include a public option, although it is unlikely states would be allowed to opt out.
House Speaker Nancy Pelosi was working to determine how to design a government insurance option in the House bill, Democratic officials said, after a vote count in recent days showed that her preferred approach — which would tie reimbursement rates to doctors and hospitals to rates paid by Medicare — didn't command enough support to pass.
"At the end of the day we will have a public option" in the House bill, Pelosi told a news conference on Friday.
Some moderates have been leery of that approach because those lower rates could hurt hospitals and providers, particularly in rural areas.
After months of struggle, both houses are expected to vote in the next few weeks on sweeping legislation that expands coverage to millions of Americans who lack it and bans industry practices such as denial of coverage for pre-existing medical conditions.
Democratic moderates are skeptical of allowing the government to sell insurance, concerned that it would mark an unwarranted federal intrusion into the private marketplace and potentially jeopardize payment rates to doctors, hospitals and other providers.
Conrad, for example, has said repeatedly he could not accept a plan with payments tied to Medicare, the federal health care program for the elderly, because rates in North Dakota are too low to give doctors an incentive to treat additional patients.
The House and Senate measures aim to expand coverage to about 95 percent of the population, and include federal subsidies to help lower-income families afford coverage and permit small businesses to provide it for their employees.
The two bills differ at many points, although both are paid for through a combination of cuts in future Medicare spending and higher taxes.
Democrats hold a 60-40 majority in the Senate, counting two independents, precisely the number needed to overcome a threatened Republican filibuster. Sen. Olympia Snowe, R-Maine, voted for the health care bill that cleared the Senate Finance Committee recently, but she has long voiced opposition to a public option along the lines under consideration, as has Nelson, and other moderate Democrats have voiced skepticism. Without 60 votes, the legislation could stall even before debate began in earnest.
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Sources: MSNBC, Rachel Maddow Show, Google Maps
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