Democrats hint compromise to win Senate health care deal

Kaiser Health NewsJune 11, 2009 

WASHINGTON — Senate Democrats are offering to scrap a controversial government-sponsored health insurance provision in an effort to win more than a dozen moderate and conservative Republican votes to extend health care coverage to nearly 46 million uninsured Americans.

Sen. Max Baucus, D-Mont., the chairman of the Finance Committee, signaled his willingness Thursday to compromise to attract enough GOP support to pass the legislation in the Senate this summer with as many as 70 votes.

Baucus emerged from a morning session with key Republicans and Democrats saying he was "inclined toward" jettisoning the proposed government insurance program, which President Barack Obama endorsed last week, in favor of a new proposal to create national, state and regional health care insurance cooperatives.

Republicans oppose the public insurance option, saying it would undermine the private insurance industry and lead to a national health insurance system. Some conservative Democrats also are skeptical of the public plan option, even as they and Baucus support Obama's goals.

Baucus said that the public insurance plan option is "so opposed at this point by Republicans" that "it's basically the question of, well, gee, what do we have to do to compromise to get health care passed this year?"

While he expressed interest in the co-op idea, which was drafted by Sen. Kent Conrad, D-N.D., the chairman of the Budget Committee, Baucus cautioned that it had to achieve many of the same goals the public option would, including being national in scope, having adequate capital, offering the public a wide choice of affordable insurance and making sure it isn't eventually absorbed by the private insurance industry.

"It's not so much the favorite (plan), but it's the most talked about right now," Baucus said. "There are still a lot of questions."

Baucus and his longtime ally, Republican Sen. Charles Grassley of Iowa, the ranking Republican on the Finance Committee, frequently have asserted that a party-line vote would tarnish the legislation and undermine efforts to gain broad national acceptance of the health care changes.

Baucus has regularly convened a meeting of the chairmen and ranking Republicans on the Senate finance, health and budget panels, and has met frequently with rank-and-file Republicans in search of common ground.

"We do think there is a good number of Republicans who want to be with the thing that passes," said a senior Democratic aide close to the negotiations. "Getting a bill approaching 70 votes is the most practical and durable way of getting things done."

Republican Sens. Olympia Snowe and Susan Collins of Maine vote frequently with Democrats and are being wooed aggressively by Baucus and other Democratic leaders. They have strong knowledge of the health care system and have been major players in previous health care debates, including the creation of the Medicare prescription drug benefit and the recent expansion of the Children's Health Insurance Program.

"I really sense a genuine desire in the (finance) committee to achieve a bipartisan initiative," Snowe said yesterday.

If Baucus' version of the legislation can preserve or even increase Medicare payment rates to doctors and hospitals in rural areas, he may win the support of Republican Sen. Pat Roberts of Kansas, a member of the Finance Committee and a co-chairman of the Senate Rural Health Care Caucus.

"There are a lot members of the (finance) committee who would like to be for something, including me, but I'm not going to be for riding into a box canyon with our rural health care delivery health system," Roberts said in an interview earlier this month. "I'm going turn the horse around and say, 'Hey wait a minute. Let's at least preserve what we have and work from there.'"

Among the other senators being wooed by Democrats are Mike Enzi of Wyoming, a Finance Committee member and the ranking Republican on the Health, Education, Labor and Pensions Committee who's signaled the potential for a deal, despite his recent sharp criticism of the Democrats' handling of the legislation; and Lisa Murkowski of Alaska and Lamar Alexander of Tennessee. Murkowski and Alexander are on the health panel, which with the Finance Committee is responsible for drafting Senate legislation.

"We want health care reform this year," Alexander said. "But the president set out objectives that we don't believe are good policy. Any government-run insurance option that has the effect of running out all the other choices and amounting to a Washington takeover of health care is a non-starter."

Other senators on the Democrats' wish list appear to be less likely converts. They are: John Ensign of Nevada; John McCain of Arizona, whom Obama criticized during last year's presidential campaign for proposing to eliminate the tax exclusion on employer-provided health insurance; and Bob Corker of Tennessee, who's shown a strong interest in health care discussions, although he doesn't belong to a committee with jurisdiction.

(Kaiser Health News is an editorially independent news service and is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization that's not affiliated with Kaiser Permanente.)

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