Senate Majority Leader Harry Reid on Monday sought to assuage the left wing of his Democratic Party by deciding to include a government-run insurance plan in his health care reform bill, bypassing the lone Republican who supported the effort and ensuring a bruising political battle in pursuit of President Obama’s top legislative priority.
In an attempt to gain pivotal support from moderate Democrats, Mr. Reid also said the bill he sends to the Senate floor will allow states to “opt out” of the insurance plan, also known as a public option. But moderates withheld their backing, waiting to hear more details.
Sen. Olympia J. Snowe of Maine, the only Republican to vote for a Democratic reform bill in five congressional committees, said she was “deeply disappointed” with Mr. Reid’s decision and would not support the bill. She favored a plan to hang the threat of a public plan over private insurers to encourage them to lower costs, but not to include it in the initial health reform program.
Mr. Reid, of Nevada, offered few other specifics of his bill and declined to say whether he had the 60 votes required to overcome a Republican fillibuster.
He sent several versions of a reform bill to the Congressional Budget Office (CBO) for analysis to provide Democrats with options and to ensure he can keep under Mr. Obama’s price tag of $900 billion over 10 years. He declined to say how states could choose to leave the national plan and what criteria, if any, they would have to meet. The legislation is also expected to require all Americans to purchase insurance and impose stiff penalties if employers do not provide it.
But it’s the public option, which is also expected to be in the House bill, that has proven to be the most controversial part of Mr. Obama’s plans to overhaul the nation’s health care system.
“While the public option is not a silver bullet, I believe it’s an important way to ensure competition and to level the playing field for patients with the insurance industry,” Mr. Reid said Monday in announcing the merged bill, crafted from legislation provided by the Finance and the Health, Education, Labor and Pensions committees.
Republicans have drawn a line in the sand, promising to block any reform bill that includes the provision, which they say would lead to a government takeover of the health care system.
“While final details of this bill are still unknown, here’s what we do know: It will be a thousand-page, trillion-dollar bill that raises premiums, raises taxes and slashes Medicare for our seniors to create new government spending programs,” said Minority Leader Mitch McConnell of Kentucky. “That’s not reform.”
The loss of Mrs. Snowes support leaves Democrats to come up with all 60 Senate votes and all but eliminates Mr. Obama’s hopes for a bipartisan reform bill. While Democrats have 60 seats when two Democrat-leaning independents are included, moderates in the party are not yet convinced that the public option would control costs.
Sen. Joe Lieberman, Connecticut independent, has said he doesn’t support the public option, and Sen. Ben Nelson, Nebraska Democrat, said Sunday on CNN’s “State of the Union” that he’s “not excited” about the “opt-out” idea.
Sen. Mary L. Landrieu, Louisiana Democrat, said Monday that she’d withhold judgment until she sees the specifics of the bill and the cost estimate.
“While I remain very skeptical about a government-run national option, I want to continue to work to achieve a principled compromise that would drive down costs, increase choices and expand affordable coverage for more Americans,” she said.
Signaling the importance of gaining moderate support, the bill will also allow states to establish cooperatives, once envisioned in the Finance Committee as a compromise between public-option supporters and skeptics. The public plan will also operate under rates negotiated between the Department of Health and Human Services and providers, according to a senior Democratic aide. Rural-state lawmakers objected to any other payment system based on Medicare rates because they felt it favored wealthier, more populous states.
Liberal Democrats and advocacy groups praised the news, arguing that the public option is the only way to ensure there is a strong competitor to private insurance companies that now have monopolies in many markets.
“An opt-out clause would protect the public option, and would help secure the necessary votes to pass health care reform, without compromising on the type of coverage or level of affordability,” said Sen. John D. Rockefeller IV, West Virginia Democrat. “This will still save money and provide a real public option for people, and I am glad Leader Reid is moving forward with this strong health care reform agenda.”
Senate debate is expected to begin when CBO returns cost estimates.
The decision by Mr. Reid, who is expected to face a tough re-election fight next year, was seen as bold move even by liberals who support the measure. It comes after weeks in which the public option appeared to be on life-support in the Senate.
“Majority Leader Reid is taking the gutsy and appropriate road in fighting for the right policy, something the American people want and an issue on which every senator should be held accountable,” said Sen. John Kerry, Massachusetts Democrat.
Mr. Reid’s very public role in shepherding Mr. Obama’s top legislative priority through the Senate could backfire as Republicans consider him one of the most vulnerable incumbents next year.
Nevada has been particularly hard-hit by the economic downturn. But Mr. Reid has faced difficult election battles before and has more than $8 million in the bank.
In announcing his decision, Mr. Reid cited public opinion polls that suggest Americans favor establishing the public health insurance plan designed to compete with private insurers. A CNN poll released last week, for instance, found that 61 percent of Americans favor a government-run health insurance plan, up five perecentage points since late August.
Critics of the polls say much of the public doesn’t truly understand what the public option means and is confused by the name. Even lawmakers have provided few details on how exactly the plan would be structured.
In a bit of a marketing move Monday, House Speaker Nancy Pelosi suggested that the plan be called a “consumer option” instead.
Mr. Reid said he expects Democrats to unify to pass the bill.
“I believe we clearly will have the support of my caucus,” he said. “I believe a public option can achieve the goal of bringing meaningful reform to a broken system.”
Mr. Obama has said he prefers the measure, arguing that it would provide stiff competition to insurance companies.
“While much work remains, the president is pleased that at the progress that Congress has made,” White House press secretary Robert Gibbs said Monday after Mr. Reid’s announcement. “He’s also pleased that the Senate has decided to include a public option for health coverage, in this case with an allowance for states to opt out.”