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updated 9/9/2009 10:23:08 AM ET 2009-09-09T14:23:08

Even as President Obama seeks to answer Republican critics of his health care overhaul plan in Wednesday night’s address to a joint session of Congress, he has yet to close the sale with moderates in his own party.

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Sen. Mark Warner of Virginia, a pro-business Democrat and former governor, said he would agree to a government-run insurance option favored by the White House — the so-called public option — only if the legislation would bring health care costs under control and promote competition.

“If we do nothing, Medicare and Medicaid costs are going to continue to explode, and it’s going to blow up the federal deficit,” he said.

Before the August recess, uneasiness among moderate Democrats emerged as three House panels raced to approve a bill. Now Senate moderates are looking to the president to explain how the legislative plan will rein in costs and keep from expanding the deficit.

Mark Pryor of Arkansas, who typically seeks to find the middle ground on issues, said Obama needed to address the budget implications of an overhaul. “It is a very difficult budget environment right now,” the second-term senator said, adding that people want a health care overhaul crafted “in such a way that it doesn’t break the bank.”

Mark Begich of Alaska said he, too, was concerned about the cost. “I want to hear the financial issues around it — how’s it being paid for, what are his thoughts there, how he views the public option and those issues — but really a lot about how he’s going to pay for it.”

Begich, the first Democrat to represent his state in the Senate in almost three decades, said he hopes that the president will help him “feel more comfortable” about how legislation would preserve coverage for those who are already insured and will reiterate his support for making sure that pre-existing conditions do not disqualify an individual from coverage. And, Begich said, he wants clarity on where the president stands on the issue of a public option.

Evan Bayh of Indiana, who on fiscal matters often strays from the Democratic party line, agreed that the president needs to address how a health care overhaul would contain costs.

“I think cost control is the major issue, both how do we slow the increases in costs for American families and businesses and how do we deal with the deficit, which is being driven — in significant part — by the rising cost of health care,” said Bayh, who is also a former governor. “So that’s number one. I hope he focuses on what we can do to make it not only more affordable, but more secure and stable for the 85 percent of Americans who have coverage.”

Eyeing a public option
Throughout the August recess, a number of moderate Democrats called for a health care overhaul plan that focused on reining in costs and spending less. Some, such as Bayh and Mary L. Landrieu of Louisiana, expressed strong skepticism about inclusion of a public option.

Similarly, Ben Nelson of Nebraska has suggested he could only support a public option were it subject to a “trigger,” possibly akin to a plan floated by moderate Republican Olympia J. Snowe of Maine. A trigger mechanism would eventually allow a public option if private insurers did not meet targets for holding down costs and expanding coverage.

Nelson and Landrieu were among a bipartisan group of six senators who wrote Senate leaders in July, urging them to resist setting a timeline for action and to give the Finance Committee enough time to produce a bill with bipartisan support.

A bipartisan group of Finance Committee members — known as the “Gang of Six” — met Tuesday to review a new proposal by Chairman Max Baucus, D-Mont. It would cost less than $900 billion over 10 years and would establish a system of consumer-owned insurance cooperatives instead of a government-run public plan.

“It appears now that we have a plan that’s been laid out there by the Finance Committee that doesn’t have bipartisan support as of yet,” Nelson said. “But the chairman is seeking that support. Tomorrow night, we should have a better idea from the president as to what the president would accept in the way of a plan, and so I am anxious to hear what he has to say.”

Blanche Lincoln, an Arkansas Democrat who is facing a tough re-election campaign in 2010, said she was eager for Obama to address a host of issues after a summer of town hall meetings and public discussion.

“I think there’s a lot that we’ve all come back from our states and our meetings with, concerns and things that we want to make sure happen,” she said, adding that the goal should be “making sure it’s deficit-neutral, that it addresses the needs and concerns of small businesses and the self-employed, and those in the individual market.”

Warner said Tuesday that he would not support a public option that simply expands Medicare or Medicaid without changing the financial incentives in terms of how health care delivery is compensated.

He added that while he supports maintaining the tax-deductible status for most employer-based health care plans, he is “intrigued” by proposals to tax insurance companies that offer so-called Cadillac plans, which cost more than $30,000.

He also said he would support some sort of individual mandate for a group he called “invincibles” — those who can afford health insurance but choose not to pay for it.

Jon Tester, D-Mont., said he wanted to hear from Obama “about the overall vision on how he gets this done . . . what he wants to see in the finished product and how responsible it is both financially and as a way to move into the 21st century.” He said that he had not seen enough of Baucus’ proposal to talk about it and that the public option “is not a deal-breaker.”

“We’ve just got to get something that works for people, works for working families and businesses,” he said.

Bart Jansen, Kathleen Hunter and Bennett Roth contributed to this story.

CQ © 2009 All Rights Reserved | Congressional Quarterly Inc. 1255 22nd Street N.W. Washington, D.C. 20037 | 202-419-8500

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