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The Fight for the Public Option Hits Home Stretch -- Is Obama Hiding?

Pressure from progressives led the White House back to the public option. But will it be in name only?

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Republicans, seeing that they may have to concede defeat on their attempt to derail the public option, are now looking to scuttle health-care reform with an attack on the mandate included in all the bills -- a requirement that all Americans buy health insurance (some with government help). In the mark-up session for the Finance Committee bill, Sen. John Cornyn, R-Tex., made his argument that the mandate equals a tax on people making less than $150,000 per year -- a violation, he says, of Obama's campaign promise not to increase taxes on working families.

And the assault on the mandate doesn't end with the Senate.  In more than a dozen states, efforts are currently under way to pass legislation that would declare the mandate unconstitutional under state law. Once the health-care reform bill is signed by the president, a state with a mandate ban in place will likely try to force a constitutional challenge to the insurance requirement. While leading constitutional scholars contend that federal law would trump state law in such a contest, the challenge could gum up the health-care works, possibly delaying the implementation of health-care reform in the state that posed the challenge. And with a heavy roster of right-wingers occupying the bench of today's Supreme Court, a surprise could be in order should a challenge to the mandate find its way to the high court.

So why not strip the mandate out of the bill? Because the public option can't really work without it. The mandate is what keeps the public plan remotely affordable; it provides a pool that includes young, healthy people. Without them, you wind up with a public plan populated by otherwise uninsurable people, most of them uninsurable because they are already quite sick. And health-insurance reform without a mandate will allow insurance companies to continue to cherry-pick the healthiest consumers for their rolls.

Back in Washington, support appears to be coalescing around the prospect of a health-care reform bill that contains a public option. In the House, Greg Sargent reports, there are 170 firm votes for a bill that contains a public option. That leaves 48 more to get, which insiders contend is do-able.

The Senate is a much tougher game. There it takes 60 vote to shut down a filibuster, one maneuver likely to be employed by opponents of reform. The Democratic caucus comprises exactly 60 senators, but not all are on board with a public option. That's why progressives have targeted television advertising on Finance Committee Chairman Max Baucus, D-Mont., and Sen. Blanche Lincoln of Arkansas, both of whom seem to defy popular opinion in their states with their reluctance to embrace the public plan. (Coincidentally, both also receive a major portion of their campaign funding from the health-care sector.) Other reluctant Dems include Senators Ben Nelson of Nebraska and Kent Conrad of North Dakota.

Still, Schumer contends that at least 54 Senate Democrats are ready to vote for a bill that contains a public insurance plan. That leaves six more to get, which Schumer says can be done.

If Obama is to get his public-option deal, however, he will likely need to win over heel-dragging lawmakers with some weakened version of the plan -- something either administered by the states, and perhaps not even launched until insurance companies fail to provide affordable insurance according to some benchmark built into the bill as a "trigger." (There's some belief that, if they go that route, Senate Democrats could win a single Republican -- that of Maine's Olympia Snowe.) However, many experts,  including former Secretary of Labor Robert Reich, say that triggers don't work.