- The Washington Times - Friday, October 16, 2009

Senate Democrats are trying to develop public health insurance option that would hit the sweet spot between moderates and liberals, and maybe even some Republicans, to obtain 60 votes needed for passage.

They are considering allowing states to create any kind of public plan they want or to allow them to opt into or out of a national program.

In the House, where Democrats have a larger majority, Speaker Nancy Pelosi pledged Thursday to move ahead with a “robust” public option, which would establish a government-run national insurance program that is strongly favored by liberals.

Republicans have long said they can’t support any public option because private insurers would not be able to fairly compete with a government plan, driving them out of business.

Moderate Democrats have been somewhat skeptical of the idea as well. But they have been drawn to proposals to allow states to define and create their own public plans, or set up a national insurance program that states could opt into or out of.

“It allows other states to look at [what has been done in other states] and adopt the models that work and avoid those that don’t,” said Sen. Evan Bayh, Indiana Democrat. “If you just go with a full-blown national experiment right now and don’t get it right, that can cause some real problems.”

Modified public option plans have been in the works for weeks, but they have gained new credence in recent days as two Senate health care reform bills - one with a public plan and one without - have to be merged into one to proceed.

“We’re trying to find if there is some common ground here on the public option,” said Sen. Richard J. Durbin, Illinois Democrat and majority whip. “There’s some mechanism that’s going to create some competition with the health insurance industry.”

The three Democratic leaders working on developing a bill for the Senate floor - Majority Leader Harry Reid, Finance Chairman Max Baucus and Health, Education, Labor and Pensions Committee member Sen. Christopher J. Dodd. - say they will create a plan that can pass.

“It’s clear we’re going to pass health care reform this year,” Mr. Baucus told reporters Thursday after meeting to discuss what the bill would look like. “Every Democrat will vote for national health care reform, and I’m hopeful that several Republicans will as well. We all know that this is the moment.”

The public option has never been truly defined, but it’s goal has always been to be a strong competitor to private insurance companies. Some have called it a government-run health insurance plan. But as the reform debate moves forward, the definition will become much more important.

A proposal from Sen. Maria Cantwell, Washington Democrat, would allow states to choose whether they want to negotiate directly with insurance companies on behalf of residents who would receive government tax subsidies. The amendment passed the conservative Finance Committee and was seen as a win for public-option proponents because the state would be a position to negotiate prices for consumers.

Democratic Sens. Thomas R. Carper of Delaware and Charles E. Schumer of New York are circulating a rough proposal that would allow states to opt into or opt out of a national program.

And Republican Sen. Olympia J. Snowe of Maine has proposed establishing a trigger, which would give insurance companies a few years to reduce insurance costs under the threat of a public option. She is the only Republican who has voted for a Democratic reform plan, a fact that gives her idea some leverage with Democrats.

Democrats on Thursday also prepared a bill that would apply a 10-year boost to the Medicare reimbursement rate, a proposal that would appease physicians who have complained about the rate for years and likely go a long way toward obtaining their support for health care reform.

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