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Pelosi makes case for public health care option

House Speaker Nancy Pelosi said Thursday that the case is growing stronger for allowing the government to sell health insurance in competition with private companies, contending recent attacks from the industry should dispel any doubts.
Health Care Overhaul
House Speaker Nancy Pelosi of Calif. announces a bill that would continue health care for young Americans who could stay on their parent's insurance until age 27, on Tuesday in Washington.Harry Hamburg / AP
/ Source: The Associated Press

House Speaker Nancy Pelosi said Thursday that the case is growing stronger for allowing the government to sell health insurance in competition with private companies, contending recent attacks from the industry should dispel any doubts.

"The need for a public option is very clear," the California Democrat told reporters at her weekly news conference, making the argument as lawmakers on both sides of the Capitol work to finalize sweeping legislation extending coverage to millions of the uninsured.

Whether the Senate bill will include a public plan in any form is a major question mark, but "our House bill will have a public option," the California Democrat declared.

"Anyone who had any doubts about the need for such an option need only look at the behavior of the health insurance industry this week," Pelosi said. "The idea that we would have health insurance reform without a public option becomes less likely."

She was referring to an industry-funded study earlier that said insurance premiums would rise under health overhaul legislation advanced by the Senate Finance Committee earlier this week. Pelosi also referenced an insurance industry ad campaign targeted at seniors.

The speaker has been on the attack against health insurers for months, but the latest developments clearly strengthened her resolve to make them pay. She also said the House was now considering adding to its health care bill a $6.7 billion-a-year fee on insurance companies that is part of the Senate Finance package.

"There are some things we'd like to see happen to the insurance companies that they might not like," Pelosi said.

Baucus: All Democrats will vote for bill
Meanwhile, Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee predicted that every Democrat in the Senate — and perhaps more than one Republican — would vote for the overhaul.

That assertion was a notable show of confidence coming in the midst of negotiations with Majority Leader Harry Reid and White House officials to finalize legislation that can satisfy liberal Democrats without alienating moderates — and get the 60 votes needed to advance in the 100-seat Senate.

Baucus told reporters that lawmakers have a moral obligation to repair the health care system to rein in costs and extend coverage to millions of the uninsured.

"And that is why we are going to pass health care reform legislation this year, and it is why every Democrat will vote for it, and it is why there will be at least one Republican and maybe a couple more who also will vote for it," Baucus said.

"Every Democrat will vote for national health care reform," Baucus emphasized.

Democrats control 60 Senate votes, but that includes two independents, and leaders have been uncertain of support from a number of moderates who've expressed concerns about the price tag of health care legislation and the government's role in a remade system.

Baucus' prediction followed approval by his committee earlier this week of a 10-year, $829 billion bill that makes numerous changes to the health care system along the lines sought by President Barack Obama, but taking a more centrist approach than the other four health care bills approved by House and Senate committees.

Baucus and Reid met Thursday with White House Chief of Staff Rahm Emanuel and other officials wrestling to merge the Finance bill with a more liberal version passed by the Senate Health, Education, Labor and Pensions Committee.

Reid later held out hope of getting support from more Republicans than just Sen. Olympia Snowe, R-Maine, who was the lone GOP "yes" vote in the Finance Committee. Snowe's fellow Maine Republican, Susan Collins, has indicated an openness to potentially supporting a bill, though she has said major changes would be needed from what the Finance Committee passed.

Unanswered is whether Reid will include provisions in the bill to allow the government to sell insurance in competition with private industry. That so-called public plan is supported by liberals, who spoke up in favor of it at a closed-door Senate Democratic caucus meeting Thursday.

But because of opposition from moderate Senate Democrats, any public plan Reid does include likely would be some type of compromise, such as leaving the decision on a public plan to states or offering public coverage only as a backstop in areas where one insurer has a lock on the market — the approach favored by Snowe.

"I favor a public option. Everyone knows that," Reid added.

Using Medicare reimbursement rates?
It's been clear for some time that the House health overhaul bill would likely include a public plan, but its design remains unsettled. However, the stronger version favored by liberals — one that would use reimbursement rates to providers based on Medicare rates — may be gaining favor.

Pelosi supports that version though she said a final decision hadn't been made. She said that if people are going to be required to purchase health insurance — as all the health bills on Capitol Hill contemplate — they need to have access to the cheaper rates government insurance could offer.

"If you are going to mandate that people must buy insurance, why would you throw them into the lion's den of the insurance industry without some leverage with a public option?" she asked.

Pelosi didn't rule out or in supporting a compromise public plan but said that when the House and Senate meet for negotiations on their respective health care bills, she wants the House to have passed the strongest public plan version possible.

"I want to send our conferees to the table with the most muscle for America's middle class," she said.

A spokesman for an industry group, America's Health Insurance Plans, said in response to Pelosi's comments that "the American people want policy makers to pursue reforms that are in the best interest of the country, not as retaliation for speaking out about rising health care costs."

Spokesman Robert Zirkelbach also reiterated concerns about the government option, which the insurance industry and other business groups contend could drive private insurers out of business because they wouldn't be able to compete with the weight of the federal government.

"Any time an entity can be both a player on the field and the referee there can't be fair competition," Zirkelbach said.

Democratic leaders in the House and Senate are aiming to finalize their bills in time to begin floor debate in each chamber within weeks, though likely not this month. Obama wants to sign a bill this year. Overall, the legislation would carry a price tag around $900 billion over 10 years, require most people for the first time to purchase insurance, provide subsidies to help lower-income people do so, and put new requirements on insurance companies to prevent them from charging much more to older people or denying coverage to people with pre-existing conditions.

Obama will aim to rally support for the overall effort next Tuesday by appearing in a live Web cast to be shown at house parties organized by his backers.