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Democrats Scrutinize Latest Senate Health Care Proposal

By Alex Wayne, CQ Staff

December 9, 2009 -- Democratic leaders in both chambers were briefing their rank and file on Wednesday on a Senate proposal to replace a so-called public option in the health care overhaul with an alternative that includes expanding Medicare eligibility.

Details were still scarce about the proposal, put together by a group of 10 Democrats and outlined Tuesday evening by party leaders. The full Senate Democratic Caucus was awaiting a 5 p.m. briefing on the plan, which leaders have sent to the Congressional Budget Office for a cost estimate.

"There's really just confusion about what's in the proposal," said a senior aide to a House Democrat who attended a briefing led by Rep. Rosa DeLauro, D-Conn.

The new proposal would effectively scrap a government-run insurance plan like the one that the House-passed health care bill (HR 3962) would create to compete with private insurance offerings in a new exchange, or marketplace.

Instead, individuals ages 55 through 64 would be able to buy into Medicare, the health coverage entitlement now open only to those age 65 and older. Second, the proposal would create a new system of private, national health insurance plans administered by the Office of Personnel Management, which already manages health benefits for federal employees.

Senate aides did not contest those details after Senate Majority Leader Harry Reid, D-Nev., announced an agreement on the new policy Tuesday evening. But while Reid said that it was "not true" that the public option would be dropped as part of the agreement, it appears he may have been employing a broad definition of the term.

One Senate aide said Wednesday that the proposal does not include a new government-run insurance plan of any kind. Instead, insurers who offer plans to federal employees under the Federal Employee Health Benefits Plan would be required to make the same plans available nationwide to the broader public if the government can't find at least two entities willing to offer national plans independently.

The proposal would not require private insurers offering plans in the new exchanges to spend at least 90 percent of their revenue on medical benefits, the aide said. The 10 Democrats who developed the proposal considered that idea, but apparently rejected it, along with a proposal to provide expand Medicaid eligibility to people at 150 percent of the federal poverty level, up from the 133 percent level already included in the Senate bill (HR 3590).

Some Democrats consider the Medicare buy-in option better than creating a new government-run insurance plan within the exchanges the bill would create.

Rep. Anthony Weiner, D-N.Y., a deputy whip in his chamber, called the Medicare buy-in "way better than the public option," and he put his face in his hands when asked about other liberals who expressed skepticism about the proposal.

"Expanding Medicare is an unvarnished, complete victory for people like me who support a single-payer system," Weiner said. "Never mind the camel's nose—we got his head and neck in the tent."

The public option, he noted, was itself a compromise proposed by people who would prefer simply to expand Medicare to cover every American, or enact some other kind of single-payer system.

"We shouldn't fall in love with our compromise position when they're giving us our ask," he said.

Skipping Conference?
Meanwhile, there was increasing talk among rank-and-file Democrats on Wednesday that their leaders might bypass a House-Senate conference committee on the health care bill and try to clear the Senate's version—once one is finally ready—through the House without further changes. That would be the fastest way to put a bill on President Obama's desk, possibly even by the end of the year.

Democratic leaders aren't saying much about their end-game strategy, since Senate passage appears at least a week away. But Speaker Nancy Pelosi, D-Calif., was cool to the idea of bypassing a conference.

"Why would we not have a conference?" Pelosi asked. "No, we're going to have a conference . . . We'll see when we see paper."

Still, some other Democrats indicated the idea was under consideration.

"I think we should keep it in our arsenal of tools," said Rep. Diana DeGette, D-Colo., the chief deputy whip.

Majority Leader Steny H. Hoyer, D-Md., said he was open to the idea of reaching agreement through informal negotiations, with the chambers possibly volleying versions back and forth. "We could do that," Hoyer said.

But he added that lengthy negotiations would probably be required to resolve major differences between the two bills. "The Senate has made some pretty dramatic changes . . . and the members will have to look at that," Hoyer said.

He added, "My point is we're not going to see a conference by the end of the year unless the Senate passes something by Friday, which I don't expect to happen. If they don't pass it by Friday, we're scheduled to get out on the 18th. I am very focused on the week of the 21st, which is Christmas week, being an off week, and I'm not trying to deviate from that, unless I thought we could get a conference report done on the 21st or 22nd. If they don't pass a bill until the end of week, I don't think that's possible simply from a staff standpoint and a technical standpoint."

Rep. Raul M. Grijalva, D-Ariz., who is co-chairman of the Progressive Caucus, said he wanted a conference held so that liberals could make a last stand for the public option.

"To jettison it without a fight would be demoralizing to our base," he said. "It would put progressives in a yes or no position where no is the only option."

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