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Getting Public Option Through the Senate Will Require Deft Maneuvering

By Drew Armstrong and Kathleen Hunter, CQ Staff

Can a "public option" pass in the Senate when the chamber starts voting on its health care overhaul—and if so, what would it look like?

Those are questions facing Senate Majority Leader Harry Reid and his staff as they work to craft a health care bill to bring to the floor in the coming weeks.

To get the bill to the president, Reid, D-Nev., will have to carefully thread the legislation through a number of procedural hurdles, holding his caucus together when he has to move forward, and letting some members break away when he can afford to lose them.

Along the way, Reid will have to assuage the left-leaning members of his party who are fierce advocates of a government-run alternative, while not losing the support of too many of the handful of moderates who oppose the types of public option proposals that have been floated in congressional committees so far.

At each point in the process, moving the legislation may demand a slightly different balance of policy in the bill to keep it alive.

Senate Democratic leaders are working with the White House—which strongly supports a public option—to combine bills by the Finance Committee and the Health, Education, Labor and Pensions Committee, with floor debate possible as soon as next week. (The Finance Committee is expected to vote to approve its bill this week.)

The immediate dilemma facing Reid is whether to include a public option in the merged bill and what form that public option would take.

Talking with reporters Oct. 1, Reid stressed that a public option could exist in multiple forms.

"I favor a public option...we're going to do our very, very best to have a public option," he said. "But remember, a public option is a relative term. There's a public option, there's a public option and then there's a public option. We're going to look at each of them."

The first barrier will be the most difficult. To invoke cloture on the bill and block a Republican filibuster, Democrats will likely need every one of their 60 caucus votes. On amendment and passage votes after cloture, the threshold falls to a simple majority.

Technically, the public option could be put into the bill at any time—as soon as it is introduced formally and before any votes are taken, or as late as a last-minute insertion during House-Senate conference, without the Senate having approved it before then.

It is also possible that Reid would first try to introduce a bill with a public option, understanding that it might fail—and give Democrats the opportunity to blame Republicans for blocking it.

If that happens, exactly when the public option goes into the bill gets far more complicated.

"We are going to have a public option before this bill goes to the president's desk," Reid said to Nevada voters during a conference call on Oct. 1, according to the Las Vegas Review Journal.

But exactly when the public option goes into the bill is far more complicated. Reid's two top lieutenants—Richard J. Durbin and Charles E. Schumer—have both said in recent days that they think there is broad support within the Democratic caucus for a public option and are lobbying the caucus to expand that support in advance of the upcoming floor debate.

"I have talked to every one of our more conservative members and they are open to some form of public option," said Schumer, D-N.Y.

But including a public option in a merged base bill could be dicey. To win the cloture vote on the bill, Reid and other top Democrats have almost no margin of error. With exactly 60 votes, they can overcome a Republican threat to block the bill but cannot afford to lose a single member.

Finance Chairman Max Baucus, D-Mont., insists there are not 60 votes, an analysis backed up by moderates such as Evan Bayh of Indiana, Mary L. Landrieu of Louisiana and Ben Nelson of Nebraska, who largely oppose the public option.

Democrats are hoping that Olympia J. Snowe of Maine will offer a crucial Republican vote for cloture, which would offer a small margin of error as well as at least a sheen of bipartisanship. But that is only one vote, and Democrats could lose several.

"It would be very difficult for it to get 60 votes with a bill that has the public option in it," Nelson said. "Unless it's something that I can support, I'm not going to support it...Otherwise, I'm in a position of having put my procedural votes on auto-pilot, and I have no plan to do that."

Analysts agree. "The last thing the leader would want to do is have the public option in the composite bill...because the composite bill would fall," said Bill Hoagland, chief lobbyist for the health insurer CIGNA.

"The first question is whether the public option will be included in whatever bill the majority leader brings up," said Alec Vachon, a health care consultant with Hamilton PPB. "Likely no, because they don't want to give a reason for any Democrat to vote against cloture...Then it will be up for advocates of the public option to offer amendments."

And from a political perspective, Democrats may want to protect vulnerable moderates in swing states—like Blanche Lincoln of Arkansas—from a vote on the public option until as late in the process as possible.

"You need them for cloture, so you want to get the most inoffensive bill to the floor," Vachon said.

If Reid includes a watered-down public option, it would fall to liberal Democrats like Schumer and John D. Rockefeller IV of West Virginia to muster the votes for a stronger version, post-cloture. "It'll be up to Rocky and Schumer to offer public option amendments," Vachon said.

That would spare lawmakers like Lincoln from having to vote for it. "There are those moderate Democrats in sensitive elections next year who would probably prefer not to vote on it in the Senate," Hoagland said.

Rockefeller and Schumer have played that game once already, in the Finance Committee. They offered public option amendments that were rejected by the panel, including Lincoln. The committee is generally considered more conservative than the Senate as a whole.

"This was the toughest terrain for us, the Senate Finance Committee," Schumer said after the Sept. 29 committee vote. "It's easier on the Senate floor, and then it gets easier still in conference."

The best chance seems to be by amending it into the legislation post-cloture, when Democrats only need a simple majority.

It's an approach Nelson appears to favor over including the public option initially. "It's much harder to strip something from a bill," Nelson said. "I think the public option on the front end of the bill is very detrimental to the passage of the bill."

The House has recently given Senate advocates of the public option some hope. House Democrats say they have won over conservative and moderate Democrats there.

Rep. Diana DeGette, D-Colo., a deputy whip for Democrats, has spent recent days meeting with the New Democrat and Blue Dog caucuses to shore up their support for the idea.

"Based on my efforts the last couple of weeks, we do have the votes for the public option in the House," she said.

Four of the eight Blue Dogs on the House Energy and Commerce Committee voted for the House bill (HR 3200) out of committee, after securing a compromise that included not having the public option base its rates on Medicare.

DeGette said she has been talking with Durbin, D-Ill., about sending a handful of the House moderates to try to convince on-the-fence senators to support the public option.

Durbin said he is still trying to win over those moderate senators. "I've talked to some of them and heard their concerns," he said. "They are worried about reimbursement questions and we have to address those questions if we ever want to win their support, but I think that is a legitimate feeling about the public option that can be addressed."

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