Healthcare reform: Can Democrats give up public option?

As Obama calls on Congress to pass reform, the Democrats are still split on the need for a public health insurance option.

Charles Dharapak/AP
Senate Majority Leader Harry Reid of Nev.,accompanied by House Speaker Nancy Pelosi of Calif., speaks to reporters outside of the White House in Washington, on Tuesday, after a meeting with President Barack Obama about health care reform.

As President Obama prepares to speak at a joint session of Congress, the lines in the sand over a public option in healthcare reform are wearing thin for Democrats.

Speaker Nancy Pelosi says there will be no healthcare reform legislation in the House without a public option. Democratic centrists say the Senate cannot pass any bill that has a public option in it.

But there is broad and robust agreement among Democrats on a more critical point: Congress must move on healthcare this fall. Put another way: It’s time for leadership – and not only from the White House.

“We as a caucus know where we are and what we can get,” said Senate majority leader Harry Reid after a caucus lunch today.

Sen. Max Baucus (D) of Montana, who chairs the Senate Finance Committee, has been leading bipartisan negotiations over healthcare reform with the so-called Gang of Six since last spring, signaled Wednesday that he is about out of patience.

“There is a time and a place to discuss and to reach decisions," he said. "Today, I told leadership, the president, Democrats, ranking member [Charles Grassley] and others that next week we are going to mark up a bill."

But he also signaled that a public option won't be part of that bill. “Senate Democrats know the importance of passing healthcare reform and also know that to get it passed, we need 60 votes,” he said after the caucus meeting today. With the loss of Sen. Edward Kennedy (D) of Massachusetts, Democrats – including the two Independents who vote with them – are down to 59.

The public option is a non-starter for Republicans, too. But for now, the minority party isn't the issue. Democrats need to rally their own members around a bill and restore momentum to their president’s agenda.

The great divide

On one side of the intra-party fault line are the dozens of conservatives and moderates that gave Democrats their majorities in the House and Senate. Many got hammered at home over the August recess by voters alarmed at the prospects of a big government role in healthcare.

On the other side are party progressives who campaigned on a public option and don’t want to see it negotiated away. They say the public alternative to private health insurance is critical, because it gives private insurers incentive to lower the cost of healthcare

“It’s important to have a genuine incentive to insurance companies to respond. Otherwise, the only incentive for them is just to accept more payments and then go on doing what they’ve done before,” says Rep. Neil Abercrombie (D) of Hawaii, a member of the Congressional Progressive Caucus.

Hawaii has had a public option for health coverage since 1974.

In a leadership shuffle today, Sen. Tom Harkin (D) of Iowa left his chairmanship of the Senate Agriculture Committee to chair the Senate Health, Education, Labor and Pensions Committee left vacant by Senator Kennedy. Sen. Blanche Lincoln (D) of Arkansas became the first woman to chair the Agriculture Committee.

Still optimistic

“Do I think a public option is still possible? With the right leadership and the president weighing in, yes I do,” said Senator Harkin, after Wednesday's caucus meeting.

Harkin says that it’s important to have floor votes on a public option to see where Democrats stand. “Three committees in the House and one in the Senate have passed a public option. To say that the Senate doesn’t have 60 votes when you’ve never tried it means you’re not for the public option,” he said.

“We need to find out why someone opposes a public option, and to say: What else can we do for you that will make you more comfortable voting or the bill? That’s leadership,” he adds.

Freshman Sen. Jeanne Shaheen (D) of New Hampshire says that she still supports a public option, but "my first priority is getting healthcare passed and figuring out how to get the votes to do that."

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