Personal Health

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?

UPDATE: The Senate Finance Committee hasdelayed the vote, originally scheduled for Tuesday, on its health-care reform bill, pending receipt of a cost assessment from the Congressional Budget Office. The vote is expected to take place later this week. Committee member Ron Wyden, D-Ore., is refusing to say whether or not he will vote for the bill,according to theOregoniannewspaper, after committee Chairman Max Baucus, D-Mont., refused to let Wyden offer an amendment to the bill that would, according to theOregonian's Dave Sarasohn, "allow people who have health coverage from their employer to go into the bill's insurance exchange and see if they can find a policy, or a company, they like better." Sen. Jay Rockefeller, D-W.V., another committee member who has been critical of the bill, is also not saying whether or not he will cast a "yea" vote on Baucus' bill. We'll keep you posted.

For months, as Congress has debated health-care reform, President Barack Obama's tepid rhetoric about  the importance -- but not the necessity -- of a public health-care plan has caused anxiety among progressives.

Then the left got serious. When word dropped, via Politico, that Obama might use the occasion of his health-care speech before a joint session of Congress to skirt the public option, the Progressive Change Campaign Committee gathered a group of former Obama campaign staffers together (including a manager of the campaign's field operation) to sign a petition calling for the president to hold to his promise for the public option.

As former Obama staffer Mike Elk stated on AlterNet, "health care reform without a public option is not 'change we can believe in.'" Just a day before the speech, the petition and the list of signers ran as a full-page ad in the New York Times, garnering widespread television and radio coverage. Consequently, perhaps, the president gave a chunk of his speech to explaining his preference for a public insurance plan. Still, Obama seemed less than committed to a fight-to-the-finish on behalf of the public option.

Progressives weren't content to leave it there. The Progressive Change Campaign Committee teamed up with Democracy for America to launch television ads targeting senators -- including Democrats -- who stand in the way of the public option. PACs began raising campaign funds for pro-public option legislators, and the Accountability Now PAC promised primary challenges to those who fell out of step with progressive priorities like a public health insurance plan.

Lo and behold, the ground seemed to shift further with this weekend's news that President Obama and members of his administration have been quietly talking with reluctant lawmakers, trying to cut a deal for a public option.

It's hard to say whether Obama is responding to pressure from the left, or was always inclined to step back publicly from the public option while quietly cutting a back-room deal for its survival. But it's safe to say that the pressure from the left hasn't hurt, even if one Democratic senator, a public-option advocate, contends it has. But the senator in question, Chuck Schumer of New York, almost has to say that: He's deeply involved in getting fence-sitting Democrats to come his way on the public plan when it's time for a vote.

With one committee left to vote on its bill later this week, Senate leadership will soon begin the work of hammering out that body's final health-care bill, a combination of the legislation drafted by the Health, Education, Labor and Pensions Committee, which contains a public option, and the one expected to be offered by the Finance Committee (the committee will vote on its bill today), which does not. If the final Senate bill does not include the public plan, Senate Majority Leader Harry Reid has signaled that he will carry the issue to the Senate floor in the form of an amendment. Failing that, the public plan could still survive via a budget maneuver when the House and Senate bills are reconciled in the conference committee.

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.

As the health-care reform bill wends its way through Congress, there's only one thing worth betting on: Some sort of health-care bill will pass into law. It looks like the bill will contain something called a public option. But whether it will represent true reform is anybody's guess.

Adele M. Stan is AlterNet's Washington bureau chief.