latimes.com/news/nationworld/nation/la-naw-healthcare-reid27-2009oct27,0,4995758.story
latimes.com
Senate healthcare bill to include public option, Reid says
The majority leader says states would be allowed to opt out of the
government-sponsored insurance plan.

By Noam N. Levey

1:34 PM PDT, October 26, 2009

Reporting from Washington

Fueling the push for a new government insurance plan, Senate Majority
Leader Harry Reid (D-Nev.) said today that his chamber's healthcare bill
would include a compromise that would create a nationwide public option
but give states the right to opt out.

"The public option is not a silver bullet, [but] I believe it's an
important way to ensure competition and to level the playing field for
patients with the insurance industry," Reid said. "Under this concept,
states will be able to decide what works for them."

Reid sent the proposal to the nonpartisan Congressional Budget Office to
be analyzed today, a key step before he can bring a bill to the floor
for debate.

His decision does not settle the debate roiling Democratic ranks over
how to create a government plan that would give consumers who don't get
coverage through their employers an alternative to plans offered by
commercial insurers.

The "opt-out" compromise is still two votes shy of the 60 Reid needs to
overcome a Republican filibuster, according to a senior Democratic aide
on Capitol Hill who requested anonymity when discussing the plan.

And while Reid expresses a preference for the opt-out proposal, others
continue to push for an alternative, known as a "trigger," that would
establish local public options around the country only if commercial
insurers did not provide affordable plans to consumers.

That scenario is being championed by Sen. Olympia J. Snowe of Maine, the
only Republican to vote for the healthcare reform measure approved by
the Senate Finance Committee.

With a 60-40 voting majority, which includes two independents who caucus
with Democrats, Reid has to hold all his members or pick up Republicans
to head off a filibuster.

Reid and House Speaker Nancy Pelosi (D- San Francisco) are advancing
separate healthcare bills in the Senate and House, which would have to
be reconciled later this year before they are sent to the White House
for President Obama's signature.

But Pelosi indicated Friday that the opt-out alternative could be
included in a reconciled bill.

For now, House Democrats are poised to pass a bill that would create a
nationwide government plan, although there is still disagreement about
how much such a plan should pay doctors, hospitals and other medical
providers.

Liberals, including Pelosi, favor a proposal that would link those
payments to the existing Medicare program, which often pays providers
less than commercial insurers. Proponents believe such an arrangement
would save money and help drive down costs.

But many conservative Democrats, particularly from rural areas where
Medicare typically pays less, want the government plan to negotiate its
rates with providers, as commercial insurers do.

Pelosi hopes to settle those differences in time to unveil a bill later
this week, according to her office.