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To Pass, Health Bill May Have To Ditch Public Option

Michelle Poland of Bryan's Road, MD, rallies against the Senate's health care reform bill outside Capitol Hill on Nov. 21, 2009 in Washington, DC.
Brendan Hoffman
Getty Images
Michelle Poland of Bryan's Road, MD, rallies against the Senate's health care reform bill outside Capitol Hill on Nov. 21, 2009 in Washington, DC.

It will be another week before senators begin floor debate on the Democrats' health care overhaul bill, but many in Washington are already predicting the demise of its current provision for a modest government-run insurance program.

Emerging as a top contender to replace the so-called public option in the Senate bill is a trigger plan that would impose a government option in states where private health insurers fail to meet benchmarks for expanding coverage.

That's a compromise long advocated by GOP Sen. Olympia Snowe of Maine, and one that even Democrats say they increasingly see as the most possible path to get President Obama's top legislative priority passed — maybe even before his January State of the Union Address.

There's been a lot of bluster and bluff all the way around on this issue. But these folks will not let one aspect of a measure drag it down.

"I think you're going to see a trigger option at the end of the day," says longtime Democratic strategist Peter Finn.

"There's been a lot of bluster and bluff all the way around on this issue," he said. "But these folks will not let one aspect of a measure drag it down."

The turn of events has infuriated party progressives — including some who have vowed to vote against any final plan that doesn't include a more robust government plan. Nonetheless, vote counters say shedding it may be the only way to move the bill out of the Senate and into final legislation negotiations between Democratic leaders and the White House.

Besides, says Thomas Mann of the Brookings Institution, federal projections show that only a small percentage of Americans would likely use a government-run plan — not enough, he says, to make the provision key to current efforts to overhaul health care.

No Big Deal?


"In substance, the public option is just not that important," Mann says.

Not important enough, anyway, to stall a bill in the Senate.

And that would likely happen, despite New York Sen. Chuck Schumer's insistence that his party could get the 60 votes, or his party's entire caucus, needed to overcome GOP efforts to block the bill by filibuster.

At least three members of the Democratic caucus — Independent Sen. Joseph Lieberman of Connecticut and Democratic Sens. Ben Nelson of Nebraska and Blanche Lincoln of Arkansas — have expressed their distaste for a bill with a public option. Lieberman has said he also opposes a trigger option.

And public option skeptic Democratic Sen. Mary Landrieu of Louisiana has warned that there aren't 60 votes to pass the current Senate version.

So Democratic leaders, and the White House, are now wooing not only Nelson, Lincoln and Landrieu, but also two moderate Republicans — Snowe and her Maine colleague, Sen. Susan Collins — to get an overhaul bill passed.

"I think the White House is really playing for five or six senators to get a minimum of three," says Christian Potholm, a government professor at Bowdoin College in Brunswick, Maine, and a close follower of his state's senators.

He predicted that if Democratic leaders can fashion a bill that could gain Snowe's support, Collins would "grit her teeth and go along as well." Democrats find Collins less predictable on the issue.

Defer The Debate?

There is a slim possibility that Senate leaders will decide to push through a bill with no public option, no trigger — no government-type plan at all, Mann says, and figure it all out later.

"Democrats really would rather defer this conversation until the end game," Mann says.

The end game is the conference committee. That's when party leaders, along with the White House, would hammer out final compromise legislation from the Senate plan and the House bill, which includes a public option.

Besides, congressional Democrats already face other intra-party squabbles over whether to help pay for a health care expansion by taxing rich benefits plans like those enjoyed by many union members, or by imposing a new tax on the wealthy. There's also bitter disagreement over whether legislation should impose further limits on a woman's access to legalized abortion.

"The public option is a huge issue," says Republican strategist Ron Bonjean, "but it's not just that. There are a lot of other controversial items in the bill that will come out now."

Controversy Outsized To Its Effect

The so-called public option, once considered key to the party's effort to advance President Obama's key domestic initiative, is not just wilting for lack of 60 reliable votes in the Senate to overcome a Republican filibuster.

It's also expected to be on its way out — at least in its current form, which in the Senate would allow states to opt out of the proposed government plan if they choose — because the controversy surrounding the public option has turned out to be outsized to its ultimate effect.

And a continued uncertain economic environment has complicated the political reality of selling a government health care plan.

Senate Democrats still retain the option of using a procedural maneuver called reconciliation that would allow them to pass legislation with a simple majority of the 100-member Senate. But there has been a growing reluctance to use that gambit.

"It may still be loosely on the table, but they want to do this without it," Fenn says.

Defining Victory

So with difficult battles looming in coming weeks, and a final health care overhaul proposal still a work in progress, what must emerge for the president to declare success?

"If Democrats fashion a ham sandwich, call it a health care bill, and sign it into law, that will be characterized as a big victory," Bonjean says, only half joking.

But even without a public option, the president can legitimately claim success, Mann and Fenn say, if overhaul legislation expands the ranks of the insured, bars insurance practices that cap lifetime coverage and refuse coverage to people with pre-existing conditions, and starts down the path of controlling costs.

"That," Mann says, "would be a massive achievement."

The public option, they say, can wait for another day.

"This is such a complicated, difficult problem," Fenn says, "that it isn't going to be solved in one fell swoop." Or maybe even in several.

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