Some Democrats Say Healthcare Public Option Is Not Out

The Senate Finance Committee is expected to vote on Baucus's plan this week.


Two attempts by progressive Democrats to add a public insurance plan to Sen. Max Baucus's healthcare bill were shot down in the Senate Finance Committee last week. But the fight is not over, and the public option is not dead.

The first attempt, led by West Virginia Sen. Jay Rockefeller, a liberal Democrat, failed 15 to 8. The second, led by New York Sen. Charles Schumer, was defeated 13 to 10. In the latter case, only three Democrats—Baucus, Sen. Kent Conrad of North Dakota, and Sen. Blanche Lincoln of Arkansas—voted with Republicans against it.

Had two more Democrats voted yes, the public option, which advocates say will lower healthcare costs by competing with private insurers , and which critics see as a slippery slope to nationalized healthcare, would now be part of the Senate's bill.

Baucus, in fact, seemed almost apologetic for his vote. He noted that he had included a public option in the healthcare reform outline he put forth last year. But as committee chairman, he said, his task now is to support what has the best chance of passing the Senate. "No one has showed me how we count up to 60 votes with a public option in the bill," Baucus said. "I want the strongest bill I can possibly get."

The committee wrapped up debate last Friday and is expected to vote on the bill sometime this week, once it receives estimates from the Congressional Budget Office about how much the bill will cost. Assuming the committee approves the bill, one pressing question in the next few weeks will be how hard advocates will fight to add the public option before it gets to a Senate floor vote and what they'll have to do to win over unconvinced colleagues.

Of the two defeated amendments, Schumer's approach stands more of a chance with the full Senate. The difference reflects the way each would set up a government-run plan. Under Rockefeller's proposal, the plan would pay doctors Medicare rates, which are often below what it costs for doctors to do business and are particularly low in rural areas. Schumer's plan would not tie rates to Medicare.

Conrad, one of the Democrats who voted against both public options, said that despite his vote, he was impressed by Schumer's approach. "I think it is a significant improvement," he said last week, after noting that Medicare payments for North Dakota doctors are among the country's lowest and that state hospitals have warned that a public option paying those rates could force them out of business.

But it's not clear whether liberal Democrats will be able to win over moderates like Conrad or Lincoln, who faces a tough re-election battle, or, for that matter, Sen. Olympia Snowe, the moderate Republican from Maine who voted against both public options but whose vote is being widely courted by Democrats. Part of this uncertainty will have to be resolved by Senate Majority Leader Harry Reid, who is in charge of combining the Finance Committee's bill with the Senate Health Committee's reform bill, which passed this summer. The latter, unlike the Finance bill, has a public option.

But the biggest test will most likely come later this year, when the House and the Senate have to work out differences in their bills (assuming they get that far). Despite the setback on the Senate side, in fact,many House Democrats aren't giving up on their favorite provision. Since last week's votes, House Speaker Nancy Pelosi has repeatedly pledged that the bill will have a public option.