WASHINGTON — The idea — beloved by President Barack Obama and liberal Democrats — that any overhaul of the nation's health care system should include a government-run insurance option to compete with private insurers is losing important political momentum.
Democratic leaders of the Senate and the House of Representatives wouldn't guarantee Tuesday that the "public option" would be in the final version of the legislation. Neither chamber's leaders would rule out backing alternative co-ops — member-run health care consortiums comparable to credit unions — instead, an alternative that's popular with moderates but not with liberals.
The continuing struggle among Democrats over such fundamental points of how to overhaul health care is delaying Congress' timetable. While Obama and Democratic congressional leaders had hoped that the House and Senate would approve their separate versions of a plan before taking an August recess, neither chamber is likely now to vote before September, and then their versions would have to be reconciled and approved by each chamber again, a process that probably will stretch on for months.
"We think the public option is very important," said House Majority Leader Steny Hoyer, D-Md., but "we have to see what the Senate does on co-ops, and see how it's formulated, to see whether or not it would have a similar effect."
"It's really premature for me to lay out what should be in this bill," said Senate Majority Leader Harry Reid, D-Nev., when he was asked about the public option.
Six Senate Finance Committee members, three from each party, are hoping to complete an agreement on their version of a health care overhaul by the end of next week. Because theirs is the only high-level bipartisan effort to craft a bill — which would enhance its chance of enactment — it's being watched closely, and they're expected to recommend a system of co-ops rather than a full-scale government insurance program.
Removing the public option would lift a huge political burden from moderate and conservative Democrats, who are skittish about backing a plan that Republicans blast as a major step toward a big-government takeover of health care.
Obama has been pushing a public option for months, and he addressed the concern Tuesday before an AARP audience: "We do think that it makes sense to have a public option alongside the private option."
"And I have to say, the reason this has been controversial is, you know, a lot of people have heard this phrase 'socialized medicine.' And they say, 'We don't want government-run health care,' "he said, adding, "Nobody's talking about that."
Liberals shudder at the idea of removing a public option.
"There are rumors that the leadership is getting squishy" on the public option, said Rep. Eliot Engel, D-N.Y., a member of the House Energy and Commerce Committee, which also is trying to write a version of health care legislation.
"Some of us have pushed back hard and said we will not support a bill if it doesn't have a public option," he warned. "There comes a point where some of us will say getting a bill out at any cost is not a panacea if it's a bad bill."
A "public option" generally means a system in which the federal government would offer a health-insurance plan to all Americans. Lawmakers say that Obama hasn't pushed hard for such a plan. Sen. Olympia Snowe, R-Maine, one of the six Finance Committee negotiators, said that when she mentioned co-ops versus public options to the president, he didn't push her either way.
"The president has not inserted himself specifically into our discussions," she said.
The Finance Committee co-op details are still being formulated, but under the proposal by Sen. Kent Conrad, D-N.D., who's also one of the six negotiators, groups would be set up much like today's credit unions or rural co-ops. The groups could be owned by the people who are being covered, operate as nonprofits and get government "seed" money to start.
Among the advantages, Conrad said, is that a co-op approach wouldn't be the kind of national, one-size-fits-all corporation that a government-run plan would be. In addition, he said, co-ops could help lower health care costs because they could bargain with local physicians and hospitals for lower rates.
The idea is gaining appeal, said Sen. Ben Nelson, D-Neb., who's a swing vote.
"The talk about this stopped for a while, after President Obama said several times he wanted the public option," Nelson said, "but now it's being discussed again, and there will be movement toward this."
The idea still faces significant opposition.
The Senate Health, Education, Labor and Pensions Committee's health-care overhaul bill included a public option. Once the Finance Committee writes its version, the Senate leadership will have to combine the two measures into one bill for the full Senate to debate.
Reid was noncommittal about his next move.
"What I think should be in the bill is something that I will vote for according to my conscience when we get this bill to the floor," he said, "but I have a responsibility to get a bill to the Senate floor that will get 60 votes that we can proceed toward."
In the House, two committees have endorsed a public option, and a third, the Energy and Commerce Committee, is writing its legislation this week.
"It's a strong position in the House, and it still is. We cannot pass a House bill without it," House Ways and Means Committee Chairman Charles Rangel, D-N.Y., said of the public option.
The co-op idea could gain support in the Energy and Commerce Committee, however, since seven of its 36 Democrats are part of the Blue Dog Coalition, a group of 52 House Democratic moderates and conservatives who are balking at the liberals' bills.
Rep. Mike Ross, D-Ark., the chairman of the Blue Dog Health Care Task Force, said his group saw a public option as a "fallback" to be used only if private insurers didn't take significant steps to insure everyone.
So far, the Blue Dogs haven't been satisfied.
"We're not ready to support a bill yet," said Rep. Baron Hill, D-Ind.
(Margaret Talev contributed to this story.)
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