White House lobbies for public plan in final bill

WASHINGTON — Despite months of outward ambivalence about creating a government health-insurance plan, the Obama White House has launched an intensifying, behind-the-scenes campaign to persuade divided Senate Democrats to take up some version of the idea for a final vote in coming weeks.

President Obama has cited his preference for the so-called public option. Yet, faced with intense criticism over the summer, he strategically expressed openness to health cooperatives and other ways to offer consumers potentially more affordable alternatives to private health plans.

Senior administration officials, however, have been meeting with senior Democratic staff almost daily in the past week to discuss ways to include a version of the public plan in the bill that Senate Majority Leader Harry Reid, D-Nev., plans to bring to the Senate floor this month, according to senior Democratic congressional aides.

Among those regularly in the meetings are Obama's top health-care adviser, Nancy-Ann DeParle, aides to Reid, and staff from the Senate Finance and Health committees, both of which developed health-care bills. The measure that goes to the floor will be an amalgam of the two bills, put together by Reid and key Democrats. The Health Committee bill contains a government plan; the Finance Committee version does not.

Obama also has been reaching out to rank-and-file Senate Democrats, telephoning more than a dozen in the past week to press the case.

Delay on last bill

With lawmakers still working out details of their legislation, senators learned Monday that a Finance Committee vote on its bill will be delayed to later this week, and perhaps next week.

The Finance Committee wrapped up work Friday, but Chairman Max Baucus, D-Mont., promised members that they would have a "reasonable" amount of time to review the bill's price tag, as assessed by the nonpartisan Congressional Budget Office. That report, aides said, will arrive later than expected.

The panel's vote is expected to be close, and passage could hinge on a handful of senators who have indicated that the CBO report may sway them.

Separately Monday, the president spoke to a gathering of doctors from every state in the White House Rose Garden. Obama invoked the critical support he has from doctors and from the American Medical Association, which has given qualified support to his health proposals.

"Every one of you here today took an oath when you entered the medical profession," he said. "It was not an oath that you would spend a lot of time on the phone with insurance companies. You took an oath so you could heal people. The reforms we're proposing will help you live up to that oath."

Democratic leaders also took heart from endorsements on a health-care bill from some high-profile Republicans.

Former Health and Human Services Secretary Tommy Thompson teamed with former House Majority Leader Dick Gephardt, D-Mo., in citing "troublesome and unresolved" issues in the Finance Committee's bill. The two men nevertheless urged Congress to get the job done. "Failure to reach an agreement on health reform this year is not an acceptable option," they wrote. "It is time for action."

Former Medicare and Medicaid administrator Mark McClellan, like Thompson a prominent member of President George W. Bush's administration, also urged lawmakers to seize the moment. "The health-care problems facing this country are urgent and large, and we need to do something about them," he said. "I don't want to miss this opportunity."

Their comments came on the heels of former Senate Majority Leader Bill Frist telling Time magazine that he "would end up voting for" an overhaul were he still a Tennessee senator. Frist, a heart surgeon, later qualified his position to ABC News Radio, saying the Finance Committee bill is "not where I want it to be. It's going to cost way too much, and we're not going to get all the uninsured into the marketplace."

Let compromises begin

With a formal vote on the Finance Committee bill on the horizon, senior Democrats in the House and Senate are working on detailed compromises. Democrats hold majorities in both houses, but nailing down those majorities has not been easy, particularly in the Senate where Democrats need 60 votes to head off a Republican filibuster. The party has a 60-40 majority, including two independents, but several centrist Democrats have reservations about parts of Obama's health-care agenda.

No issue has proved more divisive than the proposal to create an insurance plan operated by the federal government and offered to some consumers as an alternative to private insurance.

Favored by liberals as the best protection for consumers from high premiums charged by private insurers, a government plan still is viewed warily by many centrist Democrats and all Republicans. Two proposals to create such a plan were defeated in the Finance Committee last week.

Those votes were viewed by some as the death knell of the public option, but the White House and its congressional allies are under heavy pressure from the Democratic Party's liberal base to breathe life back into it.

So Democratic leaders are looking for ways to insert a form of the concept into a Senate bill without jeopardizing centrist support.

To that end, Obama is lavishing attention on moderate lawmakers while he continues to talk up the public option.

He has met repeatedly with Sen. Olympia Snowe, R-Maine, who has floated a "trigger" proposal that would allow states to set up government plans as a fallback if private insurers did not control premiums.

The president also has discussed health care at least three times with Sen. Ben Nelson, D-Neb., one of the most outspoken Democratic critics of the public option.

When Obama spoke by phone with Sen. Maria Cantwell, D-Wash., last week, he made a point of the breadth of support for the public option, Cantwell said. She authored a proposal to let states set up public plans, which Democrats added to the Senate Finance Committee bill Thursday.

Democratic leaders also are laboring to reverse the impression that the public option is a politically risky vote for centrist Democrats.

And at a meeting of Senate Democrats last Tuesday, Majority Whip Dick Durbin, D-Ill., marshaled polling data from districts represented by conservative Democrats that showed a majority would back the requirement that Americans obtain health insurance so long as there was a public option.

"To argue that this is some fringe position is to ignore the obvious," Durbin said.

The nonprofit Kaiser Family Foundation's September health-care survey showed 57 percent of Americans support the creation of a "public health insurance option similar to Medicare," down 2 percentage points from the August and July surveys.

Still, Obama and Reid are treading carefully. The White House also remains sensitive about being viewed as dictating what lawmakers should do.

"You get a lot of resentment when the White House comes in to do Congress' job," said Dan Meyer, a lobbyist who served as President George W. Bush's last legislative-affairs chief and was a longtime senior aide to House Republican leaders.

Compiled from the Los Angeles Times, Tribune Washington Bureau, The Associated Press and The Washington Post