Hopes are running higher than ever for supporters of creating a government-run public option as part of healthcare reform.
The question is not settled and the healthcare reform project itself is far from guaranteed to succeed but liberals see mounting evidence that their position is going to prevail.
Democratic leaders in the House and Senate still have key decisions left to make and liberals remain nervous that President Barack ObamaBarack ObamaFive takeaways from Trump's inauguration Michael Reagan: Trump's fighting words rattle Washington Obama's post-presidential vacation delayed by bad weather MORE’s interest in attracting Republican support for reform is stronger than his preference for the public option.
But mounting evidence suggests that it is no longer a question of whether healthcare reform will include a public Instead, it has become a question of what kind of public option there will be.
“I think there’s little doubt about it at this point. We’re definitely going to see a public option in both of those bills,” said Richard Kirsch, the national campaign manager of Health Care for America Now, a union-backed liberal activism group.
Although House Speaker Nancy Pelosi (D-Calif.) has not yet secured the 218 votes she needs to pass either of two proposed versions of the public option, there is little chance the legislation will contain no such plan. “It definitely will be in the House bill,” said Rep. Frank Pallone (D-N.J.), who chairs the Energy and Commerce Committee’s Health Subcommittee.
In the Senate, Majority Leader Harry ReidHarry ReidThe DC bubble is strangling the DNC Dems want Sessions to recuse himself from Trump-Russia probe Ryan says Trump, GOP 'in complete sync' on ObamaCare MORE (D-Nev.) has strongly signaled his intention to include a public option in healthcare reform legislation by shopping around a compromise proposal that has gotten the nod from liberals and the tentative acceptance of a handful of centrists.
Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Tom HarkinTom HarkinGrassley challenger no stranger to defying odds Clinton ally stands between Sanders and chairmanship dream Do candidates care about our health or just how much it costs? MORE (D-Iowa), has long cited an alliance with as many as 52 Democratic senators who support the public option. That number has grown, Harkin said Friday.
“I thank that maybe three or four, five – somewhere in there – who were … a little bit skittish about that have become more inclined to support some sort of public option,” Harkin said. If Harkin’s assessment is correct, Reid would be as few as three senators shy of the 60 votes he needs to defeat a filibuster against the healthcare reform bill. “I firmly believe that we have 60 votes to proceed,” Harkin said.
Liberals see a more advantageous dynamic at play than they did back in August. Not only were angry outbursts at town hall meetings televised nightly during the congressional recess, the Senate Finance Committee, the only panel not to approve a public option in its bill, was at the center of attention, Brown said.
“I think that there was a real danger that there would not be a public option,” Pallone said. “Now, I think it’s the opposite.”
Asked to explain the cause of the shifting dynamic in the Senate, Harkin answered: “Five letters: P-O-L-L-S.” Public option proponents have long cited opinion polls showing voters supported their positions but Harkin and other lawmakers said an ABC News-Washington Post poll issued Tuesday had a noticeable impact.
The survey found that 57 percent of voters back the public option while 40 percent oppose it. In August, the same poll showed support at 52 percent, down from 62 percent in June.
In addition to the poll numbers, Harkin credited a strong push by labor unions, a powerful Democratic constituency. “Organized labor has intensified its lobbying efforts on this,” he said.
“It’s pretty hard for someone, the face of all that, to say they’re opposed to the public option,” Harkin said.
The key in the Senate seems to be whether Reid can persuade centrist Democratic hold-outs to back – or at least not help Republicans filibuster – a bill with an alternative public option proposal.
The so-called opt-out public option has lately gained traction in the Senate. Under this proposal -- originally conceived by centrist Democratic Sen. Tom CarperTom CarperPruitt says his EPA will work with the states Dems prepare to face off with Trump's pick to lead EPA Justice, FBI to be investigated over Clinton probes MORE (D-Del.) and modified and heavily promoted by Sen. Chuck SchumerCharles SchumerThe Hill's 12:30 Report Why Democrats fear a successful inaugural address from Trump CBO: 18 million could lose coverage after ObamaCare repeal MORE (D-N.Y.), a prominent public option supporter – the public option would launch nationally but states would be permitted to withdraw from the program.
Schumer’s version of the opt-out proposal has won over his fellow public option supporters. “I’m okay with that,” Brown said. “I think that makes sense for Leader Reid to go to the floor with the opt-out.”
Harkin said he prefers the full-scale public option in his committee’s bill but could support the opt-out compromise. “If that’s what’s in the bill that’s on the floor, I’d be comfortable with that,” he said, echoing remarks from earlier in the week by Sen. Jay RockefellerJay RockefellerObama to preserve torture report in presidential papers Lobbying world Overnight Tech: Senators place holds on FCC commissioner MORE (D-W.Va.), one of the staunchest advocates of the public option.
Liberals have rejected other such compromises, such as an “opt-in” version or Republican Sen. Olympia Snowe’s (Maine) idea to establish a “trigger” that would activate the public option in states underserved by private health insurance. Triggers, Rockefeller said in a statement Friday, “are not a substitute for a strong public health insurance option.”
After Obama met with Pelosi, Reid and other Democratic leaders Thursday, the White House repeated its message that Obama supports the public option but will not rule out the trigger or any other compromise.
That is not good enough, Harkin said. “I’ve not been very happy with the White House’s lukewarm support of the public option,” he said, articulating a gripe liberals have been making for months.
“I would hope the president would speak out more forcefully in favor of the public option,” Brown said, adding “I expect he will.”
Pallone suggested that Obama’s hands-off approach to the details of healthcare reform legislation has been the right one, however, and questioned whether the president taking a stronger position on the public option would make a difference. “I’m sure he would if it’s helpful – and it’s hard to read if it would be,” Pallone said.
Despite the fact that neither the House nor Senate even has a final healthcare reform bill, public option proponents are already looking to strengthen their position during an eventual House-Senate conference committee to combine the two bills.
“If we get that in the Senate version, I think that shows the strong support for the public option” in the final bill, Brown said.
Signals that the Senate is leaning toward considering a bill with a public option have even influenced the House’s approach. “When we were dealing with the idea that the Senate would have nothing, it was really important, again, to go in with the most muscle,” Pelosi said Friday. “This is about the end game now,” she said.
The final bill would still a public option of some kind, Pallone said, even though “we may have to have some compromises along the way.”