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Obama Reiterates Support For Public Health Care Plan

By Drew Armstrong, CQ Staff

June 3, 2009 -- President Obama in a letter to two key Senate chairmen reiterated Wednesday his support for their inclusion of the government run "public plan" option in a health care overhaul.

In a letter to Finance Committee Chairman Max Baucus, D-Mont., and Health, Education, Labor and Pensions Committee Chairman Edward M. Kennedy, D-Mass., Obama calls for a "hardship waiver," that would exempt some people who could not afford it from any mandate to buy insurance, another option Democrats are considering.

Until now, Obama has gone no further than outlining broad principles for a health care overhaul, letting lawmakers handle the policy. But Wednesday's letter marks a shift in strategy for this White House—and a signal that the president may be playing a more active role in dictating what type of bill he would eventually like to see.

"I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans," Obama writes. "This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest."

Kennedy has been for the idea, as has Baucus. But the issue has turned into a hot button for Republicans, who have by and large refused to support any legislation that has a government-run insurance option as part of it. Baucus, for his part, has been seeking a compromise with Republicans, working with outside policy experts on a solution that at least a handful of Republicans might vote for.

Obama's letter also touches on the idea of an insurance mandate—a requirement that everybody would have to buy some form of insurance. Under a number of proposals being considered, the government would provide subsidies to help people do so, insurers could not deny coverage, and there would possibly be restrictions on how much insurance companies could vary premiums for people.

There are concerns, though, that any mandate might put an undue hardship on poor people who have little money to spend on insurance.

"If we are going to make people responsible for owning health insurance, we must make health care affordable," said Obama. "If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it."

Obama also said that small businesses should be exempted from the requirement, a move that could build support among them, since they have in the past complained that such a mandate would force them to cut jobs.

Obama also said he was open to taking some of the responsibility for setting Medicare rates out of Congress' hands and giving them to the Medicare Payment Advisory Commission, an independent board that makes recommendations on Medicare rates. Sen. John D. Rockefeller IV, D-W.Va., has already proposed such a solution, saying that Congress does not have the expertise to make proper decisions on complex Medicare payment rates.

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