- The Washington Times - Friday, October 23, 2009

House leaders said Thursday that they have the votes to pass a government-run health insurance plan and Senate negotiators appear headed in the same direction, with a clause to allow states to opt out. While significant hurdles remain to passage, having both chambers put a public plan on their floors would be a significant boost to President Obama.

House leaders reached a deal over doctor payments with rural-state lawmakers to get their support for the public plan. Meanwhile, several senators said leaders are leaning toward including the plan in their bill along with the caveat to allow states to opt out of the national program.

But conservative Democrats in the House warned that they are concerned about other provisions in the plan, namely cost and taxes. In the Senate, moderate Democrats are skeptical of the public insurance plan, even with the opt-out provision.

The moves Thursday are the most significant sign yet that the government health insurance plan is likely to be included in a reform bill that makes it to the president’s desk. Mr. Obama has supported the measure but cautioned that he wouldn’t make it a requirement and risk derailing health care reform.

The public plan has proven to be one of the most controversial proposals in the debate over remaking the nation’s health care system. Nearly all Republicans have vowed to defeat the measure over concern that it would lead to government-run health care and undermine the free market. Moderate Democrats are skeptical of the plan’s cost and how it would reimburse doctors.

But there are significant other issues in the reform bills that still need to be resolved, such as how to pay for it and whether employers will be required to provide coverage.

The public plan’s inclusion would likely rule out any Republican support. Sen. Olympia J. Snowe of Maine, the only Republican who voted for the bill in committee, said Thursday that she wouldn’t vote for the public plan with the state opt-out provision.

Moderate Democrats expressed some skepticism to the state opt-in idea as well. Sen. Ben Nelson, Nebraska Democrat, said he won’t support any government-run plan established immediately.

“I have a problem with one-size-fits-all solutions when we know very well that the differences between Nebraska and New York and California are substantial and generally I think people trust their local governments at the state level to solve many of their problems,” Mr. Nelson said.

But it has support of liberal Democrats such as Sen. John D. Rockefeller IV of West Virginia and Sen. Charles E. Schumer of New York, one of the early crafters of the idea.

“I’m getting good reaction from people on a level playing field and ‘opt-out,’ ” Mr. Schumer told reporters. “It’s in the middle.”

The public plan has an even better shot in the House, where Democrats have a larger majority. House Speaker Nancy Pelosi has said she has the votes to include a public option in the bill.

“We won’t go until we are ready, and when we are ready, we will have a great bill,” she told reporters Thursday. “All of the choices we have to make are good ones.”

Republicans said they remain opposed to a public option because it would lead to a government takeover of the health care system.

“At the end of the day, the American people want us to work in a bipartisan way to fix our current system so that it works better for more Americans,” said House Minority Leader John A. Boehner of Ohio. “We can do that without a big government takeover of health care.”

The House deal announced Thursday placates members from districts where doctors are paid less under the Medicare reimbursement system by ordering an Institute of Medicine study to correct regional disparities. The health bill favored by Mrs. Pelosi and the liberal wing of the party would tie public option reimbursement rates to Medicare rates plus 5 percent.

The compromise would also give the Institute of Medicine, part of the National Academy of Sciences, 16 months to draft a proposal overhauling the way doctors are reimbursed under Medicare in what lawmakers described as a quality, not quantity, based system.

Without the agreement, rural members made it clear they would not support a public option.

“We were not going to be able to vote for this bill unless this was dealt with,” said Rep. Norm Dicks, Washington Democrat. “We are going to insist and the leadership has promised us they are going to fight for this in conference, that this is non-negotiable.”

But rank-and-file Democrats caution that the public option isn’t the only significant piece of the legislation and for some, it isn’t even the most important provision. Other controversial measures, including a surtax on wealthy Americans and the overall cost, could still derail the bill.

“Just because you’re happy with one part - the public option - doesn’t means you’re going to vote for the bill,” said Rep. Jason Altmire, Pennsylvania Democrat.

“The public option is not going to determine my vote,” he said, listing small business credits, cost containment and the proposal to tax wealthy Americans as more important factors.

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