Cantwell's tenacity yields results on health-care bill

Among the countless amendments in the health-care-overhaul bill passed by the Senate Finance Committee on Tuesday is one proposed by Sen. Maria Cantwell that would prod other states to replicate Washington state's popular Basic Health Plan while also eliminating a massive wait list for the existing program here.

Not even the Washington Democrat calls the measure a substitute for a public option. But its inclusion in the bill is a telling example of what some call Cantwell's dogged legislative style and a penchant for pragmatism over ideology.

Her amendment would funnel federal subsidies to states that opt to create an insurance program modeled after Basic Health, a steeply discounted plan for the state's working poor. That could open up Basic Health enrollment — albeit not until 2013 — to 66,000 residents now waiting to get in.

The amendment faces tough survival odds in the Senate, and in the subsequent reconciliation with the House bill. Still, the idea has drawn praise as a focused, pragmatic solution that could provide real relief to the uninsured.

"It was a creative, out-of-the-box thinking," said Rebecca Kavoussi, public-policy director for Community Health Network of Washington, the largest group of clinics and doctors to provide care for Basic Health members. "I'm really impressed with her tenacity."

Cantwell isn't part of the Finance Committee's so-called gang of six, which wielded outsized clout on shaping the health-care bill. Still, several of her amendments, if adopted, could lead to tangible gains for patients and providers, including incentives to shift elderly Medicaid patients out of nursing homes and into homes or community-based care programs.

The Basic Health amendment in many ways was classic Cantwell: an ideological compromise borne of desire to fix what's broken, if only a part of it.

In the health-care debate, her style has stood in sharp relief to Rep. Jim McDermott's single-payer proselytizing or Sen. Patty Murray's populist defense of Medicare and consumer rights.

"When we call [Cantwell] a wonk it is a compliment, because she personally is involved in developing the policies that she advocates," said Bill Daley, a liberal political lobbyist who has known the senator for almost 30 years.

On the flip side, Daley said, "I suspect that this is the reason also that she is an enigma to some."

To some, Cantwell's deliberateness can border on opacity. Liberal groups took umbrage last summer at what they saw as her equivocations on a public option — a government-run plan that would compete directly with private insurers.

She instead seemed enamored with co-ops, nonprofit but private companies modeled after Seattle's Group Health Cooperative. During a June appearance on KUOW radio, Cantwell sounded as if she'd all but given up on the public option, prompting another guest to remark: "I don't understand why we would compromise on that. A co-op is a big compromise."

So it may have surprised Cantwell's earlier critics when, before she introduced the Basic Health amendment, she joined Sen. Charles Schumer, D-N.Y., in co-sponsoring a bona fide public option. That measure was voted down by the Finance Committee.

Cantwell denies waffling on the public option, insisting she believed all along that a government plan could provide crucial competition for private insurers. Her earlier embrace of health co-ops, she said, was simply "about getting something done."

Cantwell acknowledges that Basic Health plans would not be an adequate replacement for a public option. Though funded by taxpayer dollars, Basic Health still buys coverage from private insurance companies.

Diana Birkett, Group Health's director of federal relations and policy, said Cantwell's abiding focus has been guarding the state's interest, including remedying Medicare payment formulas that perversely penalize providers for efficient care.

"She can certainly be passionate when she wants to be," said Birkett, who served three years on the health-policy staff of Finance Committee Chairman Max Baucus, D-Mont. But Cantwell's default mode is to formulate her positions "in a reasoned, logical and evidence-based way."

Kyung Song: 206-464-2423 or ksong@seattletimes.com