Say bill can be adjusted to ease moderates’ qualms
By Lisa Wangsness, Globe Staff | November 23, 2009
WASHINGTON – Buoyed by their weekend victory on a vote beginning the health care debate, several Senate Democrats expressed optimism yesterday they could find a way to keep a government-run insurance plan in the sweeping bill.
The public insurance option in the Senate’s health care overhaul is so modest that it “will, at the end of the day, be where we end up,’’ predicted Senator Chuck Schumer, a New York Democrat who is working with moderates to find a compromise. He spoke on CBS’s “Face the Nation.’’
Democratic leaders need to win over a handful of skeptical Democrats and Republican moderates, as they did on Saturday night to proceed with debate, to get the required 60 votes to end the debate sometime in coming weeks and get to a vote on final passage. Moderate Democratic senators Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana declared they could not support the government-run plan in the bill, even though on Saturday they helped send the measure to the chamber’s floor for debate.
“I don’t want four Democratic senators dictating to the other 56 of us and to the country, when the public option has this much support, that it’s not going to be in it,’’ said Senator Sherrod Brown, Democrat of Ohio, said yesterday on CNN’s “State of the Union.’’
Debate on the Senate bill is expected to begin after Thanksgiving.
Proponents say a government-run insurance plan option would provide choice and competition for consumers and put pressure on private insurers to hold down their premiums.
The version in the Senate bill contains a number of limits restricting its ability to overtake the private insurance industry. It would be available for purchase alongside private plans in the new exchanges, or insurance marketplaces, such as the Massachusetts Health Insurance Connector. But only those who do not get affordable coverage through work could buy into it, and any state could opt out of it
In order to make sure it would not have an advantage over private insurers, it could not force providers to accept lower payments by linking its rates to Medicare. Instead, it would have to negotiate with providers as private plans do.
The nonpartisan Congressional Budget Office estimates the public option in the Senate bill would attract only 3 million to 4 million people, and its premiums would be higher than private plans’ rates. It would attract sicker people, the CBO predicted, because it would probably offer a less restrictive coverage policy than most private insurers.
Moderates say revisions are in order. Senator Ben Nelson, a Democrat from Nebraska, said he could not support the public option with an opt-out provision for states, but he might consider one where states could opt in instead.
Nelson said Saturday night he had provided majority leader Harry Reid with a two-page list of fixes he would like to see, including more restrictions on abortion coverage for plans in the exchanges and additional strategies to control health care costs.
“It doesn’t do enough to control costs, that’s for sure,’’ he said on ABC’s “This Week.’’
And Senator Joe Lieberman, an independent from Connecticut who, as a former Democrat, usually aligns himself with his old party on procedural votes, could be an even greater obstacle. He said yesterday he remains philosophically opposed to the idea of a public health insurance option and concerned that it could be a drain on the already fragile economy. He predicted it would eventually fall into debt, leaving taxpayers to bail it out.
“I don’t want to fix the problems in our health care system in a way that creates more of an economic crisis,’’ he said on NBC’s “Meet the Press.’’
He repeated his threat to vote against final passage if the public option is not removed, but Senator Dick Durbin, Democrat of Illinois, speaking on the same program, said he believed Senate leaders would be flexible and he hoped they could reach the point where they could satisfy Lieberman’s concerns. “There are may variations on the theme,’’ he said. “We are open because we want to pass this bill.’’
One alternative senators might still consider would trigger a public plan in states where the private insurance industry fails to offer affordable choices. Senator Olympia Snowe, Republican of Maine, presented this approach to a bipartisan group of Senate Finance Committee members negotiating on health care this summer, but liberals have thus far rejected it because they fear its implementation could be delayed.
Snowe, who voted in favor of the proposal the Finance Committee put forward in October, voted against moving the debate forward last night. After the vote she said she planned to continue working to amend the bill in the coming weeks, but she said she remained concerned with a number of its provisions.
She said she was disappointed the Senate had included a number of other taxes in the bill, including an increase in Social Security payroll taxes for individuals earning $200,000 and couples making more than $250,000. She also said she remained concerned that people would be required to buy unaffordable insurance.
