Democratic leadership 'leaning strongly' toward opt-out for public healthcare plan

Democratic senators continued to remain bullish on the chances of creating a government-run public option as part of health reform.

But Senate Minority Leader Mitch McConnell (R-Ky.) predicted Sunday that last week's Medicare "doc fix" vote was a sign of trouble to come for Democrats in trying to rally enough votes to push through a government-run health insurance option.

Senate Democratic Caucus chairman Charles Schumer (D-N.Y.) said on Sunday that Majority Leader Harry Reid (D-Nev.) is "very close" to getting the 60 votes needed to move forward with a healthcare reform bill in the Senate.

Schumer echoed the calls of several senators who this week said that Democratic negotiators has garned the 60 votes necessary to invoke closure on the measure. Sen. Arlen Specter (D-Pa.) last week put it in even stronger terms, saying that Reid had 60 votes for a “robust” public option.

According to Schumer, Reid "is leaning strongly" toward including a provision that would allow states to opt out of public health insurance if they want to keep private insurers.

Schumer added that the liberal senators are "able to live with" an opt-out public option under which states could decline to participate in a public program.

"We need some competition for the insurance companies," Schumer said on NBC’s “Meet the Press.” A government-run insurance plan would "have to play by the same rules as the insurance companies and it would negotiate rates with the providers," Schumer said.

Having a public option would bring competition to states that only have one or two insurance providers, Schumer said. 

Senate Minority Leader Mitch McConnell (R-Ky.) declined to predict whether or not Democrats could garner 60 votes to invoke cloture on healthcare reform or if the GOP would filibuster the bill. But he did say that Republican success in blocking the 10-year Medicare reimbursement rate increase showed that Reid lacks the votes for broader healthcare reform.

“We do know that we had the first vote in the healthcare debate last week, and it was a bipartisan majority, 100 percent of Republicans and 13 Democrats agreeing that we should not borrow a quarter of a trillion dollars at the outset,” he told ABC’s George Stephanopoulos.

The 12 Democrats and Independent Sen. Joe Lieberman (Conn.) ranged from moderate to liberal. Most cited the lack of budget offsets in the bill.

McConnell said that “all the nervousness is on the Democratic side,” because of the defections on the so-called “doc fix.”

“We know there is nervousness among Democrats over this increasing view that Congress is acting like a teenager with their parents' credit card, not worried about who's going to have to pay the bill,” he added.

But two key moderate senators indicated that they would be open to voting for healthcare reform with a public option in it.

Centrist Sen. Claire McCaskill (D-Mo.) voted against the “doc fix” but said that the vote will not serve as a bellwether for the main healthcare reform bill.

"I don't think that the vote last week should be any signal to America that we have lost the will to move forward and fix the ridiculously difficult and expensive healthcare dilemma we face in this country,” she said on ABC’s “This Week.”

“Mitch McConnell is busy on politics instead of policy,” she added.

McCaskill said she supported the public health insurance option but has not “drawn a line in the sand” regarding which type of option she would support.

She stressed, however, that any plan, if included in the final bill, would be limited in its reach.

"I think what we're going to end up with is having votes on a number of choices,” she said.

The first-term senator cited three plans: the ability for states to opt-in to a nonprofit public health plan, the ability of states to opt-out from such a plan, and option to trigger a nonprofit plan if insurance companies do not address costs within a preset timeframe. She said that 25 to 30 million would be eligible to buy insurance from a public “exchange” and that most would still receive insurance from their employer.

“The devil we know is much worse than what we are proposing to do,” she said. "You can't be a serious deficit hawk,” and not pass a bill, she added.

McCaskill’s support for the public option is a key indicator that more moderate Democratic senators are getting on board with the plan that just weeks ago was opposed by the group.

Sen. Ben Nelson (D-Neb.), one of the most important holdout votes, said that he is “not excited” about an opt-out public option. But he said he may be open to an arrangement under which states can decide whether to choose government-run healthcare insurance.

“I could look into one that states can opt in,” Nelson said on CNN’s "State of the Union." He said he cannot decide on how he would vote until he sees the “underlying bill.”

Senate Finance Committee chairman Max Baucus (D-Mont.) has said all year that a public option could not attract the needed 60 votes in the Senate and did not include it in his panel’s bill. But last week, Democratic senators suggested that negotiators are leaning toward including a plan, which is starting to attract broader backing.

McCaskill even said moderate Republicans could be encouraged to jump on board with the Democrats’ bill.

“If we got more moderate Democrats in the fold, the few remaining moderate Republicans come along,” she said.

But Democratic leaders still must hammer out key details before they can determine the integrity of their voting bloc.

Sen. Russ Feingold (D-Wis.), a noted liberal, said that he would not support a public option “trigger” because it would be an "invitation to the insurance industry to manipulate the situation."

He said “at this point, I think we need to do something fundamental,” stressing his support for a more powerful public option.