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Road Map: Public Likes a Public Plan; Senate Not So Sure

With Members heading home for the recess to talk up their efforts on health care reform, a poll showing more than 70 percent of Americans back a government-run health insurance plan has given Democrats a powerful weapon to take with them.

[IMGCAP(1)]Too bad Senate Democrats won’t be able to use it.

While House Democrats are gleefully touting the popularity of the public insurance option that is the centerpiece of their recently released bill draft, the Senate has been slogging ahead on two different paths — the Health, Education, Labor and Pensions Committee is expected to produce a public insurance option while the Finance Committee is conducting a bipartisan experiment to create independent, nonprofit health care insurance cooperatives.

With the end result in both panels uncertain and a potentially awkward merger between the two bills looming for July, Senate Democrats are likely to have a hard time touting what so many of them want — a government-run insurance plan its supporters say would help lower health care costs across the board.

That’s because you can’t tout something that you’re not sure you’ll be able to draft or pass.

Though the HELP bill has a section reserved for a public plan, the language has yet to be finalized — despite the fact that the committee markup began last week. Still, Chairman Edward Kennedy’s (D-Mass.) staff did try to take advantage of the poll Monday with a news release.

Finance, meanwhile, is pursuing the bipartisan option that few Democrats seem to want. And only a handful of Republicans appear to be willing to even entertain the idea of creating a government-backed co-op.

Senate Democrats acknowledged that the focus is not on a final bill right now, but merely getting both measures out of committee so more negotiations can take place on how to merge them into something sensible.

“What matters is getting a bill to the president that he can sign this fall — an arbitrary June date doesn’t matter at all and it only matters for inside-the-Beltway squawkers who think the world is caving in every three minutes,— said one senior Senate Democratic source. “What matters is whether the Finance Committee can come up with a bill that can pass. … It’s the bill and the support that matter, not this constructed concern about recess.—

But with the release of the New York Times/CBS poll, one influential Democrat has began to push back against the sense of inevitability that Finance Chairman Max Baucus (D-Mont.) has tried to create around his relentless pursuit of the bipartisan co-op plan.

“When we began talking about reaching an agreement on the co-op idea, the goal was to work with Republicans on an alternative to a public plan that could achieve the same objectives,— Sen. Charles Schumer (D-N.Y.) said in a statement provided by his office on Monday.

“Despite the good efforts of Senator [Kent] Conrad [D-N.D.], when Republicans talk about the co-op model, it’s clear they are not talking about anything close to a national plan with enough clout to keep insurance companies honest. I am happy to continue discussions, but make no mistake about it: to be successful, any co-op has to be available everywhere, receive significant federal funding upfront, have a national board, and have national bargaining power to drive down costs.—

Schumer, who sits on Finance but also serves as third in line behind Majority Leader Harry Reid (D-Nev.), has been trying to forge a compromise with Conrad — and Baucus — that would satisfy more liberal Members’ desires.

Of course, to really make liberals happy, a public plan would have to be central to the bill.

Republicans have said that’s a deal breaker, so passing a government-run insurance plan would likely force Democrats to pass a partisan bill using arcane budget rules that prohibit a filibuster. That’s an option Baucus has been studiously trying to avoid.

Part of some Democrats’ frustration with the Baucus bill’s trajectory is that they don’t think the effort he has so far put into wooing Finance ranking member Chuck Grassley (R-Iowa) will pay off. And even knowledgeable Republican aides said they are dubious that Grassley will sign on to Baucus’ plan.

“Sen. Grassley has been clear in his commitment to bipartisan health care reform, but there’s almost zero chance that Democratic leaders and the White House will do what’s necessary to achieve a truly bipartisan bill. Democrats will make it impossible for Republicans to support this bill,— said one senior Senate GOP aide.

Plus, some Democrats worry that Baucus is potentially falling into the same trap that allowed three Republicans to largely dictate the terms of this year’s economic stimulus bill. Because Democrats could not pass the measure without those three GOP Senators, the economic stimulus bill was shaved by $100 billion, much to the dissatisfaction of the party faithful.

Supporters of the co-op plan said it should not be underestimated as a true momentum builder in both parties.

“The co-op package has traction and, frankly, may be one way to assure Democrats and Republicans can both stand behind health care,— said one senior Senate source. “For this to be a real, sustainable piece of legislation, it has to appeal to 60 Senators. The co-op may be one of several mechanisms that can do just that.—

House Democrats, by contrast, are motoring quickly toward passage of their health bill after three Democratic chairmen jointly unveiled an 852-page version late last week.

Democratic aides said the House is entering the week with the upper hand on health care reform, buoyed by the polls showing strong support for the public option and the fact that House Democratic leaders have avoided the turf battles that plagued earlier health reform efforts.

“We’re in a much stronger place on this issue, which will pay off legislatively for the House,— said one leadership aide.

They say their bill, which includes a robust public health insurance option based initially on Medicare, would result in 95 percent of Americans being covered by insurance. And while Blue Dog Democrats and New Democrats have expressed concerns about the public plan, few House Democrats want to be seen opposing health care reform.

Some of the toughest fights remain to be worked out, including the final cost of the bill and how to pay for it, but House Democrats are much further along than their House Republican colleagues, who have only released a four-page outline.

Republicans argue that a government-run insurance option would initially undercut private insurers on price, likely causing tens of millions to leave private coverage, and eventually collapsing the private market. The loss of a competitive insurance market would eventually lead to higher costs and rationing of care, they contend.

Democrats say just the opposite — that a public plan will reduce costs by providing a robust competitor for private, for-profit companies.

House Democrats also are still hoping to bring their climate bill to the floor this week after reporting progress over the weekend in marathon bill-writing sessions among staff.

And if they can pull that off, leadership will be heading home for July Fourth ready for fireworks.

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