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Pelosi May Back Off 'Robust Public Option' If Senate Embraces Public Plan

By Edward Epstein and Alex Wayne, CQ Staff

October 23, 2009 -- Now that senators are open to a health care compromise that would include a public insurance option, Speaker Nancy Pelosi is feeling less of a need to include a far-reaching government insurance plan in the bill she plans to bring to the House floor in the coming weeks.

Pelosi, D-Calif., an ardent supporter of the so-called robust public option, has been having trouble corralling the 218 votes needed to advance the plan. She has said repeatedly that, in addition to supporting the public plan on its merits, she views it as a way of giving the House the strongest hand possible in an eventual conference with the Senate.

But that reasoning was based on the belief that the Senate would not include any kind of public option in the compromise it is expected to pass. Recent signals from a group of moderates that they would, in fact, accept some form of a public plan could lessen the need for the House to go to conference with a bill that includes the robust option.

Pelosi's Plan
The "robust" plan Pelosi favors would pay most health care providers the same rates as does Medicare, the government's entitlement program for seniors and the disabled. Physicians would get 5 percent more than Medicare pays but would be required to accept patients in the public plan if they also see Medicare beneficiaries.

"The atmosphere has changed," Pelosi said Oct. 23, after a House Democratic Caucus meeting during which leaders canvassed members about their support for the "Medicare Plus 5" formula.

"When we felt the Senate would have nothing, we felt we needed the robust public option. But now the Senate is discussing a public option," she said. "Since that is now a strong possibility, I have to begin discussing with my colleagues what is the best approach to a public option."

The other major idea, which many of Pelosi's fellow liberals oppose, is a public plan in which the government would negotiate reimbursement rates with health care providers. Providers would not be compelled to participate in the plan. That would cost more than the robust option, but some Democrats say it would be fairer to doctors, hospitals and others in the health care delivery system.

Last-Minute Caucus
Pelosi's comments indicate that she is trying to make the best of a tough situation. Majority Whip James E. Clyburn, D-S.C., was surveying members this week about whether they would support the robust option but apparently came up short of the necessary 218 votes.

On Oct. 22, all House Democrats were told to report to a "mandatory" caucus in the Capitol's basement at 9:30 a.m. the next day. Some members said such a hastily arranged meeting was a sure sign that leaders didn't have the votes for Pelosi's preferred public option alternative.

"A group does not have these meetings if they have the votes to run the bill," Earl Pomeroy, D-N.D., who opposes the robust option, said after the caucus.

Through the caucus room's closed doors, the voice of Caucus Chairman John B. Larson of Connecticut could be heard calling the names of members alphabetically. Everyone present was asked to say if he or she would support a bill with a robust public option.

The result was inconclusive, members said afterwards. Some members were absent and others said that, although they might support the public option, they still had other problems with the overhaul bill.

"The ones who didn't say yes get to go to the Speaker's office," said Gene Green, D-Texas, half-jokingly.

Jim McGovern, D-Mass., said the caucus meeting was an indication that crunch time has come. Pelosi wants to unveil a bill as soon as this week and wants the House to pass it before Thanksgiving. She and Senate Majority Leader Harry Reid, D-Nev., want to send President Obama a bill before Christmas.

"This is decision time. We've been arguing for months on this bill. It's time to make decisions and see where people stand," McGovern said.

Clyburn and Pelosi are mulling the results of the Oct. 23 caucus and other efforts to gauge where members stand.

Pelosi said that while the House bill definitely will have some form of a public insurance option, she wants to see how Senate negotiators progress. "I could argue it either way," she said, referring to negotiated rates vs. "Medicare Plus 5."

"A lot of it depends on progress in the Senate," she added.

Senate moderates are discussing a public plan that would let states create their own public insurance programs, but would also give them the option of leaving health insurance to private companies. A group of states could also band together to form regional plans.

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