Reid Gambles On Public Option In Health Care Bill

Call it Senate Majority Leader Harry Reid's big health care gamble.

The Nevada Democrat on Monday announced that the Senate's merged health care bill would introduce a government-sponsored program into the health insurance market.

But it remains unclear whether Reid, who is facing a tough re-election battle back home, has managed to corral the filibuster-proof 60 votes needed to guarantee passage of a final bill containing a so-called public option. That would include all 57 of his fellow Democratic senators and the two independents who caucus with them.

The proposal would allow states to opt out of the public plan, though details of that process were not released.

"I believe there is strong consensus to move forward in this direction," Reid said when pressed by reporters during a press conference about whether he had locked up the 60 votes needed to block Republican attempts to kill the option.

His most strongly worded response? "I feel clearly we'll have the support of my caucus to move this bill and start legislating."

Moving The Bill

Reid's move was alternately hailed as a major step by proponents of a public option or derided as a last-ditch grandstanding by opponents.

Judy Feder, a public policy professor at Georgetown University, was among those who characterized Reid's opt-out version of a public option as the best outcome that could be expected.

"I think that an opt-out is a strong position for a reluctant Senate," she says.

"It reflects real movement on the part of the Senate," says Feder, a health policy expert who served in the Clinton administration. "And that makes me optimistic that we'll see a public option as part of final legislation that goes to the president's desk."

Inserting a public option into the Senate bill obviously greatly increases the chances that a government-run option will emerge after House and Senate Democrats meet to merge their competing health care bills.

But many conservatives, including Bob Moffitt of the Heritage Foundation, said that without the guaranteed support of Reid's entire caucus, and without details on how states could opt out of the public option, there was "no there there" in the senator's announcement.

"I think he's desperate," Moffitt says. "I think he's still trying to get 60 votes."

Playing Chicken With Fellow Democrats?

Despite the political pitfalls inherent in his announcement, Reid's insertion of the public option in the proposed legislation has political potential. By including the provision in the bill instead of offering it later as an amendment from the floor, Reid guaranteed that it would require 60 votes to remove the public option provision from the legislation.

His calculation puts pressure on moderate Senate Democrats who have been leery of — if not outright hostile to — a public option, including Mary Landrieu of Louisiana, Ben Nelson of Nebraska, and Blanche Lincoln of Arkansas. Lincoln also is in a very difficult re-election battle back home, where polls have shown her trailing her GOP challengers.

"It's a game of chicken," says Mike Tanner of the libertarian Cato Institute. "His hope is that his own people are not willing to vote a whole bill down, that Nelson and the others are willing to vote cloture and get it out."

Cloture is a Senate procedural vote to end a filibuster. It requires 60 votes, or three-fifths of the Senate, to pass.

Ron Pollack, founder of Families USA, which advocates for expanding public health care, said he is convinced that Reid has the votes he needs to guarantee that a government insurance option will be included in the overhaul bill.

"A majority leader has a paramount function: To make sure he can count votes and shepherd his colleagues in a way that gets to yes," Pollack said. "I am presuming that Sen. Reid did do that."

Door Still Open For A 'Trigger' Mechanism?

The Senate legislation containing the opt-out provision, Reid said, is on its way to the nonpartisan Congressional Budget Office, which will prepare its estimate of how much the proposal will cost.

But the Senate, in its deliberations, may yet modify the bill, and the opt-out provision could eventually be melded with the concept of a mechanism that would "trigger" a public option only if certain conditions arise, says Elizabeth Carpenter, associate policy director of the New American Foundation's health policy program.

What happened Monday, she said, was "just another progression in the public option debate."

Under a much-discussed trigger system, a government-run plan would be introduced in states where there is a proven lack of affordable options from private insurers.

It's a proposal that GOP Sen. Olympia Snowe of Maine, the lone Senate Republican who has participated with Democrats in health care negotiations, has supported.

"Her support for a trigger will keep that conversation alive," Carpenter said.

Will The Public Support It?

Reid said the opt-out proposal will bring "meaningful reform to our broken system." And he hit Senate Republicans for their solid-ranks opposition.

"I'm always looking for Republicans" to work with, Reid said. "It's just hard to find them."

Republicans on Monday characterized Reid's proposal as a step down the path to a health care system that's entirely run by the government.

Senate Minority Leader Mitch McConnell of Kentucky said that Reid's "new government spending plan" is not reform.

"The core of the proposal is a bill that the American public clearly does not like," he said, "and doesn't support."

Democrats in recent weeks have been encouraged by national polls showing that a majority of Americans say they support a public option, and by the backlash aimed at the insurance industry after it issued what amounted to a warning of higher premiums if the overhaul proposal included a government-run option.

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