Moderate Senate Democrats face increasing pressure to support a health care bill that includes a public insurance option, and many appear prepared to fall in line with Democratic leaders — provided they are presented with a bill that can withstand public scrutiny in their home states.
Centrists are adamant that any bill they support must be deficit-neutral. But they are also loath to cross President Barack Obama by causing a health care bill to fail this year.
“All of us have no question in our mind that we must have health care reform and insurance reform, and we need to move a bill,— said moderate freshman Sen. Mark Begich (D-Alaska). “I think we have not done as good a job delivering the message as to what all this means in health care reform. I think the public option component, and the financial issues, are absolutely going to be debated and discussed.—
To seal the endorsement of moderates, Democratic leaders are working to wrap the controversial elements of reform in a politically attractive message to the centrists’ conservative-leaning constituents. That could include the addition of provisions aimed directly at problems or issues in each Senator’s state, such as tweaks to state funding formulas for federal programs, aides said.
Senate Democratic Conference Vice Chairman Charles Schumer (N.Y.) said last week that he has spoken with most centrists and that they are “open— to some form of a public option.
“Because we believe in Democratic unity, there is no line in the sand,— Schumer said. “Liberals haven’t put a line in the sand … the more moderate members haven’t put a line in the sand because, here’s one thing you have to remember: I think every Democrat from the most liberal to the most conservative realizes that it serves America’s interests and our own interests to pass a bill. And that is going to be a force that will help get things done.—
Both Schumer and Majority Leader Harry Reid (D-Nev.) indicated that state-specific or Senator-specific sweeteners might be added to secure centrist votes.
“We’re going to have lots of silver bullets,— Reid told reporters Thursday. “It’s not going to be just one thing. … We’ll have to work with lots of individual Senators to get this done.—
Democratic leaders and some centrists calculate that the final Senate bill is likely to include a component that critics can label a public insurance option or, in recent Republican parlance, a “government takeover— of health care. So moderates appear to be angling for the Democratic leadership to settle on a public option compromise that they can sell back home.
“It just all depends on how you’re defining a public option,— said Sen. Blanche Lincoln (D-Ark.), who voted against two public option amendments in the Finance Committee last week. “I’m not supportive of a government-run and government-supported public option. It’s got to be competitive. It’s got to create choice for people.—
With the Senate Finance Committee poised to formally approve its more centrist health care reform proposal Tuesday, Reid, along with the White House, has been gearing up to begin picking the winners and losers in the health care policy fight when he merges the Finance bill with a measure passed out of the Health, Education, Labor and Pensions Committee. The HELP bill includes a public option.
Because the Finance proposal to create nonprofit health insurance cooperatives has not gained much traction with centrists, leaders have instead focused on finding a way to create a public option that could satisfy both liberals’ and moderates’ concerns, while also bringing more competition to private insurers.
Many, including White House officials, see the answer to that problem in Sen. Olympia Snowe’s (R-Maine) proposal to create a “trigger— for a public option in the event other health insurance reforms in the bill do not successfully drive down health insurance costs nor increase coverage. The bonus, they calculate, is that Snowe would sign on to such a bill and help the leaders shore up the votes of wavering centrists.
However, Sen. Tom Carper (D-Del.), a leader of the recently formed Moderate Dems Working Group, has proposed allowing states to create public plans or co-ops if they so choose. Last week, senior Democratic aides said the proposal had significant potential as a possible compromise.
As a fallback, Senate Democratic leaders have stepped up their pressure on centrists to stick with the party on procedural votes. At a minimum, leaders have asked all 60 Democrats to allow them to bring a health care bill to the floor in order to make sure Republicans cannot filibuster it.
Democratic Senate aides familiar with the thinking of Conference moderates said centrists want to vote for a health care reform bill — even one that is politically problematic — because it appeals emotionally to their inner Democrat.
By contrast, voting for the kind of progressive climate change legislation favored by Obama and Democratic leaders is much less alluring, to the point where many moderates have all but decided not to support such a bill, particularly since they are on the verge of taking a political risk on health care.
“Most of the moderates really want to vote for health care. We’re for the little guy — we’re Democrats. It’s what we do,— said one Senate aide who works for a moderate Democrat. “Getting the message out there is going to be difficult. But no matter what we vote on, somebody is going to call it a public option.—
But many centrists remain hard sells. Sen. Mary Landrieu (D-La.) said she is “not very, if at all— open to including a public option, but she expressed a firm commitment to enact a health care bill this year.
“There’s going to be a lot more discussion with the moderate members of our Caucus over this issue and how to move forward,— she said last week. “You know, we’re all firmly committed to reform that will result in lower costs to the government — both at the federal and state levels — to businesses, and to families.—
Despite some flexibility on the public insurance option, moderate Democrats are likely to hold the line when it comes to the overall cost of the bill.
Centrists are insistent that any bill they support must not add to the federal deficit. The public opinion of Obama’s drive for health care reform sank back in July, when the nonpartisan Congressional Budget Office delivered cost estimates to various House and Senate health care bills that projected they would add billions of dollars to the deficit over the next 20 years.
The moderates, echoing the president’s pledge in his speech to a joint session of Congress last month that any bill he signs will not add “one dime— to the federal deficit, are signaling that this is a line they will not cross. Given that Senate Finance Chairman Max Baucus’ (D-Mont.) bill, pre-markup, is the only bill to receive a deficit-neutral score from the CBO, meeting this requirement is not a foregone conclusion.
“I think we’ll have health care reform. And I think we will have a bill to our president that will support doing away with pre-existing conditions, have a bill that is deficit-neutral,— said Sen. Kay Hagan (D-N.C.), another freshman moderate. “I think [the public insurance option] is definitely one piece of the pie. But I think there’s more to it than that.—