Pelosi seeks centrist support for liberal public-option healthcare proposal

Speaker Nancy Pelosi is seeking to modify the House healthcare legislation to bring centrists around to the more liberal government-run insurance option, hoping that will give her the strongest negotiating position with the Senate.

In a closed-door session with a diverse group of Democrats on Wednesday, Pelosi (D-Calif.) offered a $20 billion tweak in hospital reimbursement rates to rural lawmakers.

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She said that if House Democrats pass the public option liberals support, they could ultimately have the more centrist version of the provision when the final bill is hashed out in conference with senators, according to some of those in attendance. But many centrists doubt that, and many would prefer no public option at all.

Liberals want a public option that has rates tied to Medicare, while centrists who could accept a public option want those rates to be negotiated.

The strategy of pushing the bill to the left in order to improve the House’s bargaining position in conference is supported by liberals. But centrists, like the leaders of the Blue Dog Democrats, call it a politically dangerous strategy that will cost Democrats seats in the 2010 elections.

“When we go into negotiations with the Senate, we’ve set a higher mark,” said Rep. Raúl Grijalva (D-Ariz.), a co-chairman of the Congressional Progressive Caucus who agrees with Pelosi’s strategy. “We’ll have a better chance of preserving the concept of a public option, whether it’s trigger or negotiated Medicare rates. To go in there with something diluted doesn’t leave us any room to negotiate.”

The Senate Finance Committee did not include a public option in its legislation, and several key Democratic senators have said such a plan cannot pass the Senate. But Sen. Olympia Snowe (R-Maine) has shown support for triggering a public option if certain requirements laid out by Congress are not met.

And interest has grown in giving states the option to have a public plan.

House Majority Leader Steny Hoyer (D-Md.) said Friday that he expected a “robust” debate in conference committee.

He said he did not anticipate a vote on healthcare before the first week of November, which could put the vote right up against the Thanksgiving recess.

Pelosi also said in the meeting she believed she has the votes now to pass her more “robust” version of a public option. But she said that she wants to show unity among House Democrats rather than passing a bill with 218 members, the bare majority of the chamber.

Democrats are still smarting from the arm-twisting Pelosi employed to win 211 Democratic votes for a climate change bill in June (eight Republican votes put it over the top). Some say it led to the intensity of resistance that Pelosi has faced from some quarters of her caucus on healthcare.

A whip count being undertaken by the Congressional Progressive Caucus indicates that support for the liberal public option among House Democrats is just shy of the needed 218. There are “about 200” solid supporters, 15 leaning yes, 20 undecided and 30 “no” votes, according to a Progressive Caucus source. Of the 30 “no” votes, 23 are likely “no” votes on the overall bill, the source said.

Many centrist Democrats and essentially all Republicans are opposed to the public plan, calling it an unfair competitor to private business. But some centrist Democrats have indicated they’ll support a public option if reimbursement rates are “negotiated” rather than tied to Medicare.

Democratic leaders canceled their caucus meeting Wednesday in favor of a smaller group meeting in Pelosi’s office about the reimbursement rates, a flashpoint in the House public option debate.

There, Pelosi offered a key policy change to the “Medicare plus 5 percent” option being pushed by the Progressive Caucus and other liberal members.

Rural members have been irritated that the “plus 5 percent” went only to physicians, not hospitals. Hospitals under the “robust” option would be reimbursed at Medicare rates.

Rural lawmakers find that unfair, because in rural areas most healthcare is provided through hospitals, and there’s often only one in a region.

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“Healthcare in rural areas is in the hospitals,” said Rep. Bart Stupak (D-Mich.).

So Pelosi offered to give hospitals Medicare plus 5 percent as well, which would reportedly add $20 billion to the cost of the bill.

“I give them credit for truth in advertising,” said Rep. Earl Pomeroy (D-N.D.), a Blue Dog who is focused on reimbursement rates. But he said adding reimbursements for hospitals is not enough to win his support for the House bill.