The public option looms large in the minds of voters and certain lawmakers, but not so much in the Senate health care bill. There it limits eligibility, kicks in late, includes an opt-out provision for states, and is expected to cost more than private plans. Leaders say they had to weaken it to round up the 60 votes they need to move the bill forward. Still, its inclusion continues to jeopardize needed support for passage, because several members of the Democratic caucus adamantly oppose any public option.
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
Tomorrow on C-SPAN, it will be �Saturday Night Live� at the U.S. Senate. A crucial evening vote is expected to cap an all-day debate on overhauling health care. Democrats need 60 senators voting yes to keep a newly unveiled bill moving forward. They have 60 members in their caucus, but it's been a struggle to get them all lined up. Several remain strongly opposed to the bill's public insurance option, even though it's been scaled back, as NPR's David Welna reports.
DAVID WELNA: The public option in the Senate's bill may disappoint some supporters. It allows entire states to opt out of such a government-backed insurance plan. And rather than paying health care providers the same relatively low rates paid by Medicare, it would have to negotiate those rates just as private insurers do. Still, Senate Democrats who strongly back a public option insist the bill's version will nonetheless make a big difference. Here's New Mexico's Tom Udall.
Senator TOM UDALL (Democrat, New Mexico): The first thing that we're trying to accomplish with a public option is to inject that competition into the market, to have insurance companies be competing and this public option is going to help drive that cost down, drive it down in a dramatic way.
WELNA: But the Congressional Budget Office says the Senate's public option will have higher premiums than those of private insurers since it's expected to enroll more people with costly health problems. Republican Leader Mitch McConnell pointed out today that this public option would actually be more expensive than private plans, and McConnell sees that as a red flag.
Senator MITCH MCCONNELL (Republican, Kentucky; Senate Minority Leader): So, clearly the only way it could have a positive impact on the cost of insurance would be to subsidize cost, ration care and undercut private insurers.
WELNA: And New Hampshire Republican Judd Gregg predicts employers will eventually have to drop private insurance plans because of rising costs, pushing more and more people into the public option.
Senator JUDD GREGG (Republican, New Hampshire): This is an exercise in having the federal government basically get control over all health care. And it's being done in an incremental way. They're setting up a scenario here that won't be immediately apparent to people, but as we move through the years, it'll become apparent.
WELNA: For now, though, the CBO expects only three to four million people would choose the Senate's public option. Majority Leader Harry Reid insists he's fine with such limited enrollment.
Senator HARRY REID (Democrat, Nevada; Senate Majority Leader): Under any plan that I've seen, the most was 5.5 million. So, we're right in line with what would be an adequate and, I think, very powerful, robust public option.
Senator DICK DURBIN (Democrat, Illinois): I wish it were a bigger public option, from my own point of view.
WELNA: That's the Senate's number two Democrat, Dick Durbin. He says the realities of the Senate require a more modest public option than what he'd envisioned.
Sen. DURBIN: The realities are we need 60 votes on the Democratic side and there are some who even oppose any form of public option. Harry Reid is trying to find that sweet spot, that position that brings 60 votes together. And I'm sure each of us, including Senator Reid and myself, could write a bill more to our liking and maybe more effective in some areas, but we understand that this is the art of the possible.
WELNA: And it's indeed looking increasingly possible that Democrats will get the 60 votes they need tomorrow. Nebraska's Ben Nelson, who opposes a nationwide public option, announced today he intends to vote with fellow Democrats tomorrow to bring up the bill. Louisiana's Mary Landrieu and Arkansas' Blanche Lincoln, who also oppose a federally funded public option, have yet to declare their intentions. But Democratic leaders appear confident that even without the help of a single Republican, they'll win this bill's first big test vote.
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hide captionMajority Leader Harry Reid of Nevada passes fellow Democratic Sens. Tom Harkin of Iowa (left) and Charles Schumer of New York (right) while leaving a news conference this week on Capitol Hill.
Manuel Balce Ceneta/AP
Majority Leader Harry Reid of Nevada passes fellow Democratic Sens. Tom Harkin of Iowa (left) and Charles Schumer of New York (right) while leaving a news conference this week on Capitol Hill.
Manuel Balce Ceneta/AP
Senate Democrats will need to vote in lockstep to overcome GOP opposition to the $848 billion health care bill in a crucial vote Saturday that would move it to the floor for debate. But it's not yet clear whether Majority Leader Harry Reid can round up enough support.
Every member of the Democratic caucus is vital to reach the 60 votes needed to push the bill forward.
All eyes have been on three moderate Democrats. Two of them, Ben Nelson of Nebraska and Louisiana's Mary Landrieu, said Friday they will vote with the party.
That leaves Arkansas' Blanche Lincoln in the questionable column.
If the bill passes Saturday, that merely begins a debate on the Senate floor that could last until Christmas. If the full chamber ultimately approves the legislation, the House and Senate versions would then need to be reconciled.
The Congressional Budget Office says the Senate version of the 2,074-page bill would provide coverage to 94 percent of people in this country and cut the deficit by $130 billion in the first decade. Republicans, however, condemn the bill's price tag, which they say will wind up being more along the lines of $1.5 trillion.
Sen. Tom Harkin (D-IA) has been a big cheerleader for the bill, saying Thursday that he was "very confident that not only will the [Democratic] caucus unite around this bill, but that the American people will unite around it also."
The showdown vote — set to stay open until 8 p.m. Saturday to accommodate out-of-town senators — is a major hurdle for the health care overhaul. A failure at this stage would be a significant defeat for President Obama, who has put the issue at the top of his policy agenda.
"It's the same turkey you didn't like in August, and it's not going to taste any better on Thanksgiving," Sen. Lamar Alexander (R-TN) said of the bill, which has been wending its way through the Senate for months.
The legislation includes a so-called public option that has generated much Republican opposition. But the states would be allowed to opt out of the government insurance program, which the CBO estimates would attract 3 million to 4 million people. The House also bill also contains a public option.
That's not the only issue that has proved divisive. The Senate bill's $848 billion price tag and its language in regard to abortion have threatened to dilute Democratic support.
As written, the measure bars federal funds from being used to pay for abortions, except in certain cases, and forbids including abortion coverage as a required medical benefit. However, it would allow coverage through the public option and allow private insurers that receive federal subsidies to offer plans that include abortion coverage — in both cases, as long as no government money is used.
The U.S. Conference of Catholic Bishops opposes the compromise. Richard Doerflinger, associate director of the organization's Secretariat of Pro-Life Activities, said Reid's legislation "is actually the worst bill we've seen so far on the life issues." He called it "completely unacceptable."
The bishops were instrumental in getting the House to adopt tough anti-abortion language, forcing Speaker Nancy Pelosi (D-CA) to accept restrictions to gain the needed support, which nonetheless outraged liberals.
The House narrowly passed its version of the health care overhaul earlier this month in a 220-215 vote, with nearly all Republicans and 39 Democrats opposed. Advocates say the House bill would cover 96 percent of Americans at a cost of $1.2 trillion. To pay for the expansion, the House bill would cut Medicare's projected spending by more than $400 billion over the next 10 years.