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Obama's healthcare trade-off

By backing away from a public option, he increases the chances for his reform proposal overall.

August 18, 2009|Peter Nicholas and Janet Hook

WASHINGTON — By dropping his insistence on a public insurance option, President Obama angered some of his most loyal supporters but sharply improved the odds of passing a far-reaching healthcare overhaul.

Moderate Democratic lawmakers are now more likely to back other parts of the evolving legislation, such as prohibiting insurers from denying coverage because of preexisting conditions or cutting off benefits to ill policy-holders, as well as making it easier for small businesses to cover workers.

At the same time, the White House appeared to be making a calculation that liberals would go along with the legislation even if it lacked a provision they deemed indispensable.

The White House expressed Obama's position in calibrated language, making clear that though he preferred to include a government-run healthcare plan in legislation, its absence would not be a deal-breaker.

Speaking to reporters on Air Force One, Press Secretary Robert Gibbs said there had been no change in White House policy with respect to a government-run plan. Obama wants an insurance market that does a better job of serving consumers, he said, and doesn't consider a public option the only means of accomplishing that.

"The goals are choice and competition," Gibbs said. "His preference is a public option. If there are other ideas, he's happy to look at them. I think this is true not only for the issue of healthcare, but for virtually every other issue that he'll ever deal with in public life."

Many congressional analysts expect the House to approve some form of public plan and the Senate to reject it, setting up a showdown in the final round of negotiations -- probably late this fall.

But the political gain for Obama was clear Monday in the reaction of Rep. Rick Boucher of Virginia, one of five Democrats who opposed the bill when it cleared the House Energy and Commerce Committee in July.

Boucher said Obama's willingness to compromise on the public option had strengthened the president's hand among conservative Democrats and other skeptics without harming the basic goal of lowering healthcare costs and insuring more people.

Dropping that option, Boucher said, "creates the opportunity to pass the healthcare bill. . . . A government-operated healthcare plan is not essential" to reform.

Throughout the healthcare debate, there has been a push for a more competitive insurance marketplace -- either through the creation of cooperatives or a government plan -- that would drive prices down.

Polls have shown that a large majority of Americans favor a public option. But a vocal group of opponents, who fear an expanded federal influence in people's healthcare, have taken their case to town halls around the country during the August congressional recess. They have argued that a government-run plan would have an unfair advantage and ultimately drive private insurers out of business.

The opposition reached such a pitch, dominating news reports, that the president held three town halls of his own in recent days to rebut what he has called misinformation about his healthcare plan.

And in making clear that the public option was merely a "means to an end" -- in the words of a senior Obama official who requested anonymity when discussing administration thinking -- the president may be able to blunt some of the criticism.

Centrist Democrats on Monday said they welcomed the new White House flexibility.

Rep. Jason Altmire (D-Pa.), a second-term lawmaker from a swing district, said: "It's going to bring votes." Altmire, who was one of three Democrats to vote against the bill in the House Education and Labor Committee, said that the government plan had "become a flash point."

Families USA Executive Director Ron Pollack, a leading consumer advocate who has been pushing a healthcare overhaul for decades, said his group had been distributing a memo touting the "10 Reasons to Support the Health Care Reform Bills." A government plan was only one of them.

"The health reform bills have many critical factors designed to make healthcare more accessible and more affordable," Pollack said in an interview. He and others noted that the bills working their way through the House and Senate included provisions that would transform the way Americans get health insurance -- even without a government plan.

"The public plan is not the essential element of reform," said Jim Kessler, vice president for policy at Third Way, a centrist Democratic think tank in Washington.

When it comes to strategy, many lawmakers long have seen a concession on the government-run plan as essential to getting any healthcare bill through the Senate, where 60 votes are needed to ensure passage.

All 40 Senate Republicans oppose the public option, as do some Democrats. Majority Leader Harry Reid (D-Nev.) has been working to overcome political obstacles in the Senate, where a small bipartisan group of lawmakers has been trying to reach a compromise.

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