Health bill has public option — and opt-out

WASHINGTON — The Senate will consider whether the government should run and fund a health care plan to compete with private insurance, but states could choose not to participate in the so-called "public option."

However, the compromise plan announced Monday by Senate Majority Leader Harry Reid, D-Nev., may not win enough votes to break Congress' deadlock over how to overhaul the nation's health care system. Reid unveiled his compromise after nearly two weeks of closed-door negotiations with top White House officials and key senators.

His bid to give states the power to opt out of the government plan was aimed at winning support from up to 12 moderate Senate Democrats and one Republican, Maine's Olympia Snowe, who've expressed reservations about a more sweeping, nationwide "public option."

Snowe, however, said flatly: "I am deeply disappointed with the majority leader's decision to include a public option as the focus of the legislation."

Democrats control 60 of the Senate's 100 seats, and it takes 60 votes to overcome procedural hurdles there, so the defection of even one moderate could doom any plan. However, reluctant moderates could vote with the Democratic leadership to overcome procedural blocks, then oppose the legislation on a final vote, which would allow it to pass with only a simple majority.

Senate Health Committee Chairman Tom Harkin, D-Iowa, has estimated that there are at least 52 Senate votes for a strong public option, while the House of Representatives is seen as close to having the 218 votes it needs to pass one.

Reid wouldn't say Monday whether he thought he had 60 votes for any specific plan.

Democratic moderates were largely mum Monday on Reid's plan, but a few suggested that there's room for compromise.

Sen. Mary Landrieu, D-La., said she remained "very skeptical" of a public option, but that "I look forward to reviewing the specific language" of the legislation and learning more about its cost.

Sen. Blanche Lincoln, D-Ark., who faces a tough re-election campaign next year and said last week that she'd ruled out supporting a government-funded and -operated plan, said Monday that she'd have to see the legislation's language and assess its impact on her state before she decided how to vote.

Sen. Kent Conrad, D-N.D., is "still discussing with the leadership what's really in the public option," spokesman Sean Neary said.

Conrad's been a strong opponent of any public option with provider reimbursement rates tied to Medicare's, saying that his state's medical community is poorly paid. He hasn't ruled out backing a public system in which providers negotiate rates, which Reid said he'd support.

Another key centrist, Sen. Ben Nelson, D-Neb., had no comment.

Reid said that he chose the state opt-out compromise because "I believe there's a strong consensus to move forward in this direction." He plans to discuss the legislation today at a closed-door meeting of Democrats.

The "opt out" provision is a compromise between lawmakers who want a government alternative and those who don't. Details of how it would work were still sketchy, but states would get a year after the 2013 phase-in of the new health care plan to decide whether to participate.

It's likely that once the Senate debate begins, probably in a week to 10 days, several variations of the public option will be debated and subject to votes.

Reid's announcement won instant applause from consumer groups, some unions and liberals, and it got the enthusiastic backing of the White House.

America's Health Insurance Plans, the industry trade group, was just as quick to criticize Reid's decision.

"A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality. The American people want health care reform that will reduce costs, and this plan doesn't do that," said Karen Ignagni, the group's president.

Republicans also voiced opposition.

"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 Senate Republican leader Mitch McConnell of Kentucky.