Pelosi chooses healthcare bill with public option favored by centrists

Speaker Nancy Pelosi is to unveil a health overhaul bill Thursday that includes the public health insurance option favored by her party's centrists.

Pelosi (D-Calif.) will introduce a plan similar to what a group of Blue Dog Democrats negotiated in July to get a healthcare bill out of the Energy and Commerce Committee. The proposal calls for the officials who run the public plan to negotiate rates individually with physicians and hospitals.

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“It looks like that’s what it will be,” Rep. Tim Walz (D-Minn.) said Wednesday night after leaving a meeting where leaders laid out the bill to those Democrats in their second term in Congress. Pelosi calls them the “majority makers” because their election gave Democrats control of the House.

Pelosi has made it clear she personally supports the so-called “robust” public option that is tied to Medicare-based payment rates, as does a solid majority of the 256 House Democrats. But it has become apparent in recent days that such an option doesn’t have the 218 votes she needs to pass it with no Republican support.

Liberals have noted that while it’s clear their version doesn't have the votes, there hasn’t been a full vote count on the centrist compromise. Winning with negotiated rates assumes that House liberals wouldn't dare block President Barack Obama's signature health initiative.

But on Wednesday, as defeat became apparent, liberals did not reiterate threats to defeat the bill if it included the negotiated rates in conference.


“I am not rolling over,” said Rep. Raúl Grijalva (D-Ariz.), co-chairman of the Congressional Progressive Caucus.

“I will insist on a Medicare-plus-5 [percent] amendment on the floor so that the full caucus can vote on it. We are hopeful that the Rules Committee will allow this amendment, which has tremendous public support, to be voted on for the record.”

They will also get a chance Thursday to press their case for a public option in the final bill to Obama in a White House meeting. Many liberals have been irritated by Obama's wavering on the necessity of a public option.

Asked if her caucus would be prepared to balk at supporting a public option with negotiated rates — a threat they made in writing at the beginning of July — Grijalva’s fellow co-chairwoman, Rep. Lynn Woolsey (D-Calif.), said: “When we see what the bill says, we’ll decide if we can support it.”

Woolsey added that while Progressives don’t intend to sign off on just anything that’s handed to them, “this isn’t walk-away time."

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The negotiated rates plan is estimated to cost about $85 billion more than the Medicare-based reimbursements. To cut the number of uninsured without surpassing the $900 billion limit set by Obama, the bill will expand eligibility for the Medicaid healthcare program for the poor. The bill will also include an income surtax on the wealthy to pay much of the cost of the plan.

Other issues, most notably a stalemate between abortion-rights supporters and opponents, remain to be resolved before a vote planned for next week, said Rep. Chris Van Hollen (D-Md.), assistant to the Speaker.

The public option has caused a bitter split between the party's liberal wing and its centrists. Pelosi has been caught in the middle, favoring a public option but not wanting to risk losing the healthcare overhaul with a risky vote.

The Congressional Progressive Caucus vehemently pushed the Medicare-based public option, saying it was the best and cheapest way to expand coverage and lower costs. Most of its members support a full single-payer plan, and felt they’d compromised enough with the “robust” option.

Many centrist and rural Democrats say hospitals and physicians in their districts are already underpaid by Medicare. Other centrist Democrats, along with Republicans, oppose the public option entirely, contending that it would put private insurers out of business.

There are 47 Democrats who oppose the “robust” public option, according to a whip survey that leaked Tuesday from a meeting between liberals and House Majority Whip James Clyburn (D-S.C.).

The survey also indicates that 20 members are “leaning yes,” 12 are “undecided” and eight are “leaning no.” That leaves 168 members, a clear majority of House Democrats, as yes votes.

Liberals have contended that Clyburn and other leaders gave in too easily. And the names on the list do raise questions. For example, Rep. Jason Altmire (D-Pa.) is listed as a no. But Altmire says he’s told leadership he's fine with a Medicare-based public option. He opposes the bill as it stands because of cost and because it includes an income surtax.

Rep. Loretta Sanchez (D-Calif.) is listed as “leaning no,” even though she and Rep. Jane Harman (D-Calif.) co-authored an op-ed earlier this month supporting the “robust” option. It was titled, “Why We're Breaking With the Blue Dogs on the Public Option.”

In July, 60 liberal lawmakers threatened to vote against the bill if it included the “negotiated rates” language, though some signers indicated privately that they wouldn't really vote to block the bill.

It wouldn’t take all 60 to defeat the bill. One whip count has shown that 23 mostly centrist Democrats intend to vote against the bill regardless, according to a lawmaker involved in the counting. That means that another 13 hard-line liberals voting against the bill could defeat it.


This story was posted at 3:08 p.m. and updated at 7:35 p.m.