Prognosis improves for public insurance (WaPo)

Prognosis improves for public insurance
MOMENTUM SHIFT IS DRAMATIC Top Democrats push option in health-care legislation

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Saturday, October 24, 2009

Democratic leaders in the Senate and House have concluded that a government-run insurance plan is the cheapest way to expand health coverage, and they sought Friday to rally support for the idea, prospects for which have gone in a few short weeks from bleak to bright.

The shift in momentum is so dramatic that many lawmakers now predict that President Obama will sign a final bill that includes some form of government-sponsored insurance for people who do not receive coverage through the workplace. Even Democrats with strong reservations about expanding government's role in the health-care system say they are reconsidering the approach in hopes of making low-cost plans broadly available.

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Clyburn said the debate is no longer whether to include a public option, but "whether or not we will get this form of a public option or that form of a public option."

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Reid's calculation is that it could be more difficult to add a public option through amendments on the Senate floor than to include it in the bill and force opponents to try to find the votes to strip it out. Manley said Reid would spend the weekend canvassing Democrats on the opt-out idea and would probably decide Monday whether to include it in the Senate bill.

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As part of that painstaking lobbying effort, Pelosi told reporters that she may have to resort to a version of the public plan that would allow providers to negotiate rates, presumably resulting in more generous payments. In the Senate, a plan that ties rates to Medicare is a nonstarter.

Both Pelosi and Clyburn said they would be open to the Senate's opt-out approach. "I don't think there's much problem with that," Pelosi said. Clyburn added: "All they're debating is whether or not to allow states to opt out of it, but you'll still have the same public option."

Reid's original inclination was to leave the public option out of a final bill he is writing from measures passed by the finance and health committees. But his liberal colleagues began urging him two weeks ago to reconsider, after insurance industry forecasts that premiums would rise sharply under the Finance Committee bill, which lacked a public option. The report had the effect of prodding Democrats to look for better ways to control costs, and the public option -- strongly opposed by the insurance industry -- reemerged as a possible solution.