WASHINGTON – Democratic leaders in Congress scrambled Friday to round up votes for allowing the government to sell health insurance in competition with private industry as they struggled to finalize a health care bill that meets President Barack Obama's goals.
In a change in the Senate, long seen as hostile to the so-called public option, senior Democrats were considering including such a measure, officials said. Majority Leader Harry Reid, D-Nev., spent Friday calling and talking with wavering Democrats to test support for different versions of the plan.
A similar process was under way in the House, where Speaker Nancy Pelosi was scratching for votes in favor of her preferred version of the so-called public option, even though opposition from moderates seemed to indicate that the votes weren't there.
"We are continuing to count the votes on this," the California Democrat told reporters after a Democratic caucus meeting where lawmakers were asked to state where they stood on the plan. "By no means is the count complete."
Tensions were running high with Democrats in both chambers in the final throes of completing sweeping health care bills they want to bring to the floor within weeks. The remaining details were proving sticky but in its broad outlines the legislation would remake the nation's $2.5 trillion health care system with a new requirement for most Americans to purchase health insurance, and government subsidies to help lower-income people do so. Insurers would face new restrictions against dropping coverage for sick people or denying coverage to people with pre-existing health conditions.
"It's just a question of when, and how soon," Pelosi said.
Liberals in Congress have long viewed a public option — a sort of Medicare for the middle class — as a critical ingredient for the plan, and Obama has said frequently he favors it. But he has also made clear it is not essential to the legislation he seeks, a gesture to Democratic moderates who have opposed it.
"The president thinks that the public option is the best way to achieve choice and competition and bring downhealth care costs for the American people. And he will continue to ensure that it is achieved in the final health care reform legislation," White House spokesman Bill Burton told reporters Friday.
A new version was drawing interest: a federal public plan that would allow states to opt out. Reid was testing support for that idea and for a second alternative, which would hold government-sponsored insurance coverage in reserve and "trigger" it only if private companies weren't providing enough affordable alternatives in given states.
The "trigger" version has the advantage of being backed by Sen. Olympia Snowe of Maine, the only Republican so far to vote for health care legislation. Obama would like to end up with a health care bill with at least a hint of bipartisanship so bringing Snowe along is seen as important, and she's voiced skepticism about other versions of the public plan.
Reid and other Senate leaders met with Obama Thursday evening at the White House.
Legislation taking shape in the House is also expected to include a public option, and Pelosi indicated openness Friday to the "opt out" plan though it's not been under active consideration there.
Her preferred option would tie reimbursement rates to doctors and hospitals to rates paid by Medicare, but it didn't appear to command enough support to prevail. Some moderates have been wary of that approach because those lower rates could hurt hospitals and providers, particularly in rural areas.
Pelosi also appeared with AARP officials Friday to announce new benefits in the House bill for seniors, a crucial constituency that polls have shown have deep concerns about the pending legislation, in part because it would be paid for by cuts to Medicare providers.
Pelosi said that the bill will close a coverage gap in the Medicare prescription drug benefit over 10 years, instead of the 15 originally envisioned, and also moves up to 2010 from 2011 a new 50 percent discount on brand-name drugs purchased by seniors who fall in the coverage gap. Aides couldn't say how much the changes cost or how they would be paid for.
Both the House and Senate measures aim to expand coverage to about 95 percent of Americans.
The two bills differ at many points, although both are paid for through a combination of cuts in future Medicare spending and higher taxes.
