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Pelosi Signals Flexibility on Health Care Bill Without a Public Option

By Edward Epstein, CQ Staff

December 16, 2009 -- House Speaker Nancy Pelosi, a strong advocate of including a government-run insurance plan in health care legislation, indicated Wednesday she may not insist on including such a plan in the final version of the bill.

Pelosi, D-Calif., declined to take a firm position. "It depends on what else is in the bill," she told reporters.

The Senate is still writing its bill (HR 3590), so it remains unclear exactly what will be in the version it sends to a House-Senate conference. But Pelosi expressed confidence that Congress will send President Obama legislation for his signature early next year.

The bill being shepherded through the Senate by Majority Leader Harry Reid, D-Nev., is not expected to contain either a public option or an alternative plan that would open Medicare to those aged 55 and over.

Still, the Senate version could include a system of competing national private health insurance plans to be administered by the federal Office of Personnel Management, which currently manages benefits for federal employees.

While that is a far cry from the public option that the House included in the bill (HR 3962) it narrowly passed in early September, Pelosi indicated that it may be a satisfactory alternative. "We have to see what this OPM piece is," she said.

Some House liberals say they will insist on a public option in the final bill, or at least want the opportunity to make their case at the bicameral conference called to hammer out a final bill.

It's clear, however, that Reid has been unable to garner the necessary support for a public plan, and its inclusion in a conference report could endanger the legislation.

Pelosi said the final bill sent to Obama should not include language regarding federal funding for abortion similar to an amendment sponsored by Rep. Bart Stupak, D-Mich., and adopted by the House.

Abortion rights advocates, and the Speaker, say the Stupak language would go beyond current federal policy and further limit women's access to abortion services. While Pelosi allowed the House to consider the amendment, she says she was forced to take that step to win House passage of the measure.

Pelosi has assured abortion rights Democrats that the Stupak language would be stripped out of the final health care bill in the Senate or in conference.

Outlining a compromise, Pelosi said any abortion language should provide no federal funding for abortion services, that it should be "abortion neutral" by doing nothing to impinge on abortion rights, and that those invited to talks over the language must agree that their goal is to pass a health care overhaul.

"Stupak goes beyond those three principles," she said. "We'll come back to those principles" in the final bill, she vowed.

However, senators continue to negotiate the abortion issue, largely behind closed doors. While the Senate defeated an amendment offered by Ben Nelson, D-Neb., that was similar to the Stupak provision, another amendment is in the works.

Reid has asked a fellow abortion opponent, Democrat Bob Casey of Pennsylvania, to negotiate a compromise that could satisfy Nelson, whose vote he needs to reach the 60 votes necessary to limit debate and move toward passage of a bill.

Casey's approach may involve cutting the number of abortions by giving more aid to low-income women eligible for federal health insurance and extending tax credits for families that adopt children.

In a question and answer period with reporters, Pelosi praised Reid's efforts to move a health care bill.

"May I say how masterful he is. I think I have a challenging job, but his is even more so," she said. And she said the House bill and what she has seen of the Senate bill provide a solid foundation for the final legislation.

Pelosi insisted Congress will send Obama a health care bill that accomplishes most of the goals she set for the legislation before the president's 2010 State of the Union addressed, planned for late January. She said failure to enact the legislation would be "very bad for the American people and very bad for us," referring to Democrats.

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