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Debate easing on public insurance option

Monday, September 14, 2009

WASHINGTON -- The White House and members of Congress on Sunday played down an immediate role for a government health insurance option and turned attention to regulating insurers, with the goal of lowering costs and ensuring coverage regardless of medical condition.

After a summer taking heat on health care, President Barack Obama has gone back on offense on his top domestic issue, most notably with a prime-time speech to Congress last week. He told the nation that the "time for bickering is over" and a plan for the government to sell insurance in competition with private industry was "only a means to that end and we should remain open to other ideas that accomplish our ultimate goal."

With that statement, Obama began the difficult task of trying to lubricate negotiations on Capitol Hill, to push opposing lawmakers away from positions -- both left and right -- that were threatening stalemate. That's what happened when Bill Clinton, the last Democratic president, tried to push through an overhaul in the 1990s.

Obama's spokesman, Robert Gibbs, drove home that point again Sunday, focusing on the public option idea to help provide coverage to the estimated 45 uninsured Americans without insurance.

The president "prefers the public option. However, he said what's most important is choice and competition," said Gibbs, adding that "it is not all of health care."

Sen. Olympia Snowe, the Maine Republican who could be her party's only senator who votes with the Democrats on health care, believes choice and competition can be ensured without a government plan.

"It's not on the table. And it won't be," she said. Snowe said it is "universally opposed" by all GOP senators and "therefore, there's no way to pass a plan that includes the public option. So I think he's recognizing that."

Snowe said a better bet for now "as the means for injecting competition" are not-for-profit insurance cooperatives, designed to compete with private industry and give consumers more choices.

Such co-ops are in place in parts of the country, but their success has been spotty. And Obama will have to be convinced that such a plan can succeed.

"I have no interest in having a bill get passed that fails," Obama said, adding he intends to be president "for a while and once this bill passes, I own it."

His senior adviser, David Axelrod, contended the White House was not ready to accept that Congress would reject the public option, though he, too, said it was one solution, not a make-or-break choice.

Congressional Democrats took care to say the idea, backed by liberals and targeted by conservatives, is not a deal breaker.

"I think that's a reasonable way to go. But I think it's important to stay focused on what we're trying to accomplish," said Sen. Jeanne Shaheen, D-N.H.

While there's strong support for a public plan among House Democrats, the votes appear to be lacking in the Senate.

Snowe, who has proved a reliable collaborator with the White House, said Obama should just give up on the public option in favor of building consensus and that he should have done so during his Wednesday speech to Congress to bring Republicans on board.

"I think it's unfortunate, because it leaves open a legislative possibility that creates uncertainty in this process," Snowe said. "And I think it could give real momentum to building a consensus on other issues."

The White House, however, was reluctant to let go completely.

"We should not let the whole debate devolve into this one question -- circulate around this one question -- and lose the best opportunity we've had in generations to do something very significant about a problem that ... is just getting worse," Axelrod said.

In public, the president is working to energize his supporters and persuade those who have insurance that a health overhaul is just as vital to them as it is to those who currently aren't covered. Behind the scenes, the president's team and Democratic lawmakers are in intense negotiations aimed at cutting a deal that can pass Congress -- with or without Republican backing.

"There's a difference between campaigning, giving a good speech, and actually governing," said Sen. John Cornyn, R-Texas. "And I think we're seeing that disconnect here because the president needs to work with us to make hard decisions in order to solve the problem, not just give a speech."

Obama wants to make sure, in addition to guaranteeing affordable coverage to the uninsured, that any overhaul imposes strict measures on the insurance industry to ban companies from refusing insurance to people with medical conditions, dropping coverage when policyholders become ill and imposing caps on what a person can claim for one illness or in their lifetime.

The president said he'll be held responsible by people if an overhaul doesn't work. "So I have every incentive to get this right."

He also has to get the politics right if he's to get anything out of the sharply divided Congress.

There is general agreement in Congress on the need to place controls on the insurance industry. But there remains a huge divide over the means or even the necessity of making sure that people without health insurance have access to coverage.

The most orthodox Republicans want the government to keep its hands off the system. Their colleagues on the extreme left in the Democratic Party want to see the government take over the insurance industry, providing a single-payer system as it exists in Canada.

In the middle are Republicans and Democrats, when finally faced with voting on a measure, who will feel politically comfortable with strictures on insurance industry practices and a mechanism with the promise, at least, of reducing not only insurance costs but the out-of-control growth of medical costs.

By signaling that he can live without a public option for now, Obama may entice the likes of Snowe and other more moderate Republicans to vote for an overhaul bill in the Senate. That then leaves him the task of holding enough Democratic votes in the House to win passage there.

Gibbs and Shaheen were on CNN's "State of the Union," Snowe and Axelrod appeared on CBS' "Face the Nation" and Cornyn was on NBC's "Meet the Press."


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