Dem moderates challenge Reid on health care plan

http://www.ajc.com/business/dem-moderates-challenge-reid-175099.html

WASHINGTON — Democratic moderates who control the balance of power on
health care legislation balked Tuesday at a government-run insurance
option for millions of Americans, underscoring the enormity of the
challenge confronting Senate Majority Leader Harry Reid one day after
he unveiled the plan as a consensus product.

Republican opposition stiffened, and party leaders announced they
would attempt to strangle the bill before formal debate begins.

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Despite the obvious obstacles, senior Democrats cast Reid's draft
legislation as a turning point in the yearlong campaign to enact
President Barack Obama's top domestic priority. Sen. Max Baucus,
D-Mont., chairman ofthe Senate Finance Committee, said there is now a
"sense of inevitability, the sense that, yes, we're going to pass
health care reform, and it's going to lower costs, provide better
health insurance coverage and cover ... and reform the health
insurance market."

The proposed government insurance option long ago emerged as the
biggest flashpoint in both the House and Senate as Democrats struggle
to pass legislation that extends coverage to millions who lack it,
bans insurance industry practices such as denying coverage on the
basis of pre-existing medical conditions and slows the growth of
health care spending nationally.

But before that issue can be joined on the Senate floor, Reid's first
challenge is to gain 60 votes — the number needed to overcome a
filibuster by Republicans — just to bring the bill up, a parliamentary
maneuver so routine that a vote is rarely required.

Sen. Mitch McConnell of Kentucky, the Republican leader, announced
that in this case, members of his party will treat it as though it
were "a vote on the merits" of a bill he said would "cut Medicare,
raise taxes and increase health insurance premiums." He suggested
Democrats could expect campaign commercials next year on the basis of
the vote, and recalled that Sen. John Kerry, D-Mass., was ridiculed in
his 2004 presidential campaign for having once said he voted for a
bill before he voted against it.

Tuesday's developments illustrated the difficulties facing the
69-year-old Reid, juggling at least three separate concerns: his role
as head of the Democratic caucus, the desire to deliver on Obama's
agenda and a 2010 re-election campaign in Nevada, where his approval
ratings are low.

"This isn't over until I'm standing with President Obama and he's
signing a bill into law that delivers what Nevadans are demanding —
real health insurance reform," Reid wrote in an e-mail message to
political supporters in his home state Monday night.

The decision to include a government insurance option in his
legislation had obvious appeal for liberals who account for a strong
majority inside the Senate Democratic caucus, and it is likely to
please labor unions and party activists in Nevada.

But it has gained less-than-effusive support from Obama, who is eager
to have at least a dollop of bipartisanship for his signature domestic
issue. Sen. Olympia Snowe of Maine, the only Republican who has sided
with Democrats in committee this year, has announced she will not
support the bill Reid drafted.

Still, if Reid is pressed in coming weeks by moderates to fall back,
he can explain to liberals that he was forced to do so because his
preference — a government insurance option — proved to be unobtainable
in the Senate.

Already, that pressure is evident.

Sen. Tom Carper, D-Del., said he may seek changes on the Senate floor,
a move likely to be welcomed by moderates. He backs a government role
in states where one or two insurers control the market and premiums
are high, along the same lines as a plan supported by Snowe.
Additionally, Carper has talked of allowing other states to invite the
federal government in — the reverse of Reid's plan, in which states
would have to opt out.

That general approach, in which a lack of competition in an
individual's state would trigger a government insurance option, "is
still alive," said Sen. Kent Conrad, D-N.D.

While Reid is expected eventually to secure all 60 Democratic votes on
the critical first test to bring the bill to the Senate floor, Sens.
Ben Nelson of Nebraska, Mary Landrieu of Louisiana, Evan Bayh of
Indiana and Blanche Lincoln of Arkansas all declined to say on Tuesday
how they would vote.

In an indication of the pressure Reid faces, Bayh said the majority
leader had agreed to cut an earlier proposal for a $40 billion tax on
medical devicemakers.

"He significantly modified that proposal in a way that I understand
will not impact thousands of good-paying jobs," said Bayh, whose state
is home to Guidant Corp., a maker of cardiovascular devices, among
other major industry players. Numerous officials said Reid had agreed
to reduce the new tax to $20 billion over a decade. The officials
spoke on condition of anonymity because no announcement had been made.

Speaker Nancy Pelosi is in a similar position in the House. Efforts to
draft a consensus health care bill for a vote have been stalled for
more than two weeks. The principal stumbling block is an internal
disagreement over terms for setting fees for doctors, hospitals and
other health care providers treating patients with government-sold
coverage.

Liberals want the government to set the rate unilaterally, pegged to
the charges the government pays Medicare beneficiaries. Moderates want
the government to negotiate with the providers in setting fees.

Pelosi favors the approach liberals want, but officials say she has
all but concluded she cannot gain the necessary majority of 218 votes
for it.

House Democrats also must resolve internal disagreements relating to
abortion services and health care for immigrants before they can send
the bill to the House floor for a vote.

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Associated Press writers Julie Hirschfeld Davis, Ben Evans, Andrew
Miga, Ken Thomas, Erica Werner and Ricardo Alonso-Zaldivar contributed
to this report.

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