KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Obama Not Insisting On Public Option, Lawmakers Wrestle With Health Reform Details

Key White House advisers say President Obama is not insisting on a public option as news outlets examine which provisions could end up in Democratic health reform bills.

Politico: "President Barack Obama is pushing a public option for the final health care reform legislation, but 'he is not demanding that it is in there,' White House senior adviser Valerie Jarrett said Sunday. Her statement on NBC's 'Meet the Press' provides a glimpse into the White House strategy during private talks this week"  (Budoff Brown, 10/18).

ABC News has a transcript from an interview with senior adviser David Axelrod on 'This Week:' 

"AXELROD: Look, the president has very consistently and clearly articulated his support for a public option. He thinks that having competition within the health care system is healthy. There are some markets where one insurance company can dominate 90 percent of the market. We see that in some states. So he supports that. But -- but that doesn't mean that we -- we halt the process. There are people in the Senate -- Republicans and Democrats -- who have objections to that. We have to work through these issues, and we're going to do that. The important thing is to create -- (George) STEPHANOPOULOS: But someone is going to have to blink, aren't they? AXELROD: The important thing is to create a situation for consumers in which they have choice, there's competition, they get the best deal, and that's what we're after." (10/18).

The Washington Post sheds light on critical behind-the-scenes negotiations: "Senate Majority Leader Harry M. Reid (D-Nev.) sits at the head of a wooden table at his office as he and Sens. Christopher J. Dodd (D-Conn.) and Max Baucus (D-Mont.) work to merge two competing versions of health-care legislation into one bill. The three men will be joined by top aides as well as by members of President Obama's health-care team, led by White House Chief of Staff Rahm Emanuel. The sessions started on Wednesday and could be completed this week. The group will make such key decisions as whether to include a government-run insurance plan designed to compete with private insurance companies."

"Although much of the writing of legislation happens in closed-door meetings, congressional Republicans have sharply criticized the ongoing process. 'This bill is being written in the dark of night,' said House Minority Leader John A. Boehner (R-Ohio), adding that 'the president ought to keep his promise to the American people and open this process up'" (Bacon Jr., 10/18).

The Associated Press reports that Democratic "intraparty disputes may prove the most grueling test of all as Congress tries to write a bill that fulfills President Barack Obama's goal of extending coverage to millions of Americans and reining in rising medical costs. The disagreements extend well beyond whether or not to allow the government to sell insurance in competition with the private market, though fissures over the so-called public plan - preferred in the House, less so in the Senate - have drawn the most attention."

"Some of the toughest fights loom over what requirements employers should have to shoulder to see that their workers are covered, and perhaps stickiest of all, how to make coverage affordable and pay for extending it to millions of uninsured. … Any showdown between the House and Senate is a ways off, and will happen only if both succeed in passing their own health bills." The AP reports that floor debates could happen "within the next several weeks" (Werner, 10/18)

Meanwhile, other senators are weighing in on the shape of the final bill:

The New York Times: "Senator Tom Harkin, the chairman of the Senate health committee, predicted on Friday that Congress would pass sweeping health care legislation before Christmas. And he said it would include a new government insurance plan - the so-called public option - which would compete with private insurers. 'The vast majority of the Senate Democratic caucus is for the public option we have in our bill,'' which was approved by the health committee in July, Mr. Harkin said. … Mr. Harkin, an Iowa Democrat, said Congress would probably have to 'go outside the health care system'' to raise revenue to finance coverage of the uninsured. "That's what the House has done,'' Mr. Harkin said" (Seelye, 10/16).

Bloomberg: "Democrats shouldn't tailor a health-care overhaul to the wishes of Republican Senator Olympia Snowe and need to push for legislation that includes a government-run insurance program, Senator Jay Rockefeller said. 'We can't sort of hedge and say 'what's Olympia going to do,'' Rockefeller, a West Virginia Democrat, said in an interview on Bloomberg Television's 'Political Capital with Al Hunt,' airing this weekend.  …Senate Majority Leader Harry Reid, a Nevada Democrat, is trying to craft a final measure that satisfies conflicting demands within his party, such as whether to include a government-run plan. 'If we calculate so finely and so exquisitely, we're going to lose our leadership and our momentum," said Rockefeller'" (Dodge, 10/17).

San Francisco Chronicle: "Obscured by the war in Congress over a government-run health insurance option are several behind-the-scenes battles that could do more to transform the U.S. health care system. Sen. Ron Wyden, D-Ore., wants to open up to everyone the health care 'exchanges' that most bills limit to small businesses or individuals without employer-based plans. ... Rep. Ron Kind, D-Wis., wants to get rid of the Medicare fee-for-service model that pays doctors and hospitals by volume of services rather than care aimed to keep patients healthy. ... These and similar efforts at the fringes of the debate take aim at the most vexing part of the $2.6 trillion U.S. health system: soaring costs, which are bankrupting individuals, businesses and government, devouring wages and swelling the ranks of the uninsured. ... No bills in Congress make cost control a central feature" (Lochhead, 10/18).

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