Democrats are still struggling to find a strategy that will let them push a health care overhaul through the Senate and fulfill President Barack Obama's goal of signing a bill this year.
A day after Majority Leader Harry Reid announced that the Democratic bill would include the option of a government insurance plan, moderates in his own party lost no time Tuesday in voicing their displeasure. Reid, D-Nev., needs every Democrat to break the filibusters Republicans are vowing to mount. But some of the moderates refuse to say whether they'll stick with their leader on procedural votes, let alone those on the merits of the bill.
House health care legislation expected within days is likely to include a new long-term care insurance program to help seniors and disabled people stay out of nursing homes, senior Democrats say.
The voluntary program would begin to close a gap in the social safety net overlooked in the broader health care debate, but it must overcome objections from insurance companies that sell long-term care coverage and from fiscal conservatives.
"I'm pretty confident that it will be in there," Rep. Frank Pallone, D-N.J., a leading sponsor, said of the provision.
The focus of the health overhaul debate now shifts to whether Senate Majority Leader Harry Reid can persuade a handful of moderate senators to get behind his new proposal for a government-sponsored insurance plan.
That's no sure bet. Even Reid, D-Nev., didn't claim to have the 60 votes needed to pass his proposal when he ended weeks of speculation by announcing that the Senate version of sweeping health care legislation would include a provision for the government to sell health insurance in competition with private insurers.
Time growing short, Democratic leaders in the House and Senate still face key decisions if they are to achieve President Barack Obama's goal of passing legislation to remake the nation's health care system by year's end.
In the House, that means setting conditions under which the federal government would sell coverage in competition with private industry. The remaining disagreements among rank and file Democrats revolve largely around the fees to be paid doctors and hospitals under the plan, and whether they should be dictated by federal officials or established in negotiations.
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.
Speaker Nancy Pelosi stepped up the pressure on House Democrats on Friday to support her preferred version of legislation that would require the federal government to sell health insurance in competition with private insurers.
Her action came amid indications that Ms. Pelosi had not locked down the votes for the proposal, the most contentious element in a bill that would provide health insurance to more than 35 million people, at cost of nearly $900 billion over 10 years.
Senate Majority Leader Harry Reid closed in on clinching 60 votes for a public health insurance option Friday as two key moderates signaled they wouldn’t stand in his way – clearing a path for Reid to finish work on a bill as early as Tuesday, Democratic officials said.
The moves came a day after Reid presented his idea for a public plan with a state “opt-out” to a skeptical President Barack Obama, who didn’t balk at the idea but questioned whether Reid could truly round up the votes, two sources familiar with the Oval Office meeting said.
Speaker Nancy Pelosi counted votes Thursday night and determined she could not pass a “robust public option” — the most aggressive of the three forms of a public option House Democrats have been considering as part of a national overhaul of health care.
Pelosi's decision—coupled with a significant turn of events yesterday during a private White House meeting—points to an increasingly likely compromise for a “trigger” option for a government plan.
The Senate has long been seen as opposed to the federal government selling health insurance in competition with private industry, but now senior Senate Democrats and White House officials are strongly considering including such a measure in health care overhaul legislation, officials say.
The provision would permit individual states to drop out of the system, a design that could make it more palatable to moderates who have opposed the "public option."
Liberals in Congress view a public option as an essential ingredient to overhaul the nation's health care system, and President Barack 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.
Sens. Ben Nelson, D-Neb., and Kent Conrad, D-N.D., said in separate interviews they had been told the plan was drawing interest in private negotiations led by Senate Majority Leader Harry Reid, D-Nev., who is merging health bills passed by two separate committees into a final package to bring to the floor.
The Democrats' control of a hefty majority in the Senate — plus the House — would suggest that President Barack Obama is within reach of overhauling the nation's health care system this fall.
But the numbers mask a more complicated reality: Obama and Democratic leaders have modest leverage over several pivotal Senate Democrats who are more concerned about their next election or feel they have little to lose by opposing their party's hierarchy.