Senate supporters of including a public option in health care reform legislation Oct. 28 predicted that once lawmakers see the legislative language and understand the public option will operate on a level playing field with private insurers, the bill will garner the needed 60 votes to be approved by the Senate.

At a press briefing for reporters, Sens. Charles Schumer (D-N.Y.), Sherrod Brown (D-Ohio), and Sheldon Whitehouse (D-R.I.) expressed confidence health care overhaul legislation with a public option allowing states to opt out would be passed by the Senate.

But they said the process of getting legislation through the chamber has just begun, adding that several issues in addition to the public option are raising concerns among lawmakers, including whether insurance will be affordable for those seeking it, how the bill will be funded, the structure of an excise tax on so-called Cadillac insurance plans, and the structure of an employer mandate.

Schumer told reporters no Democrats or Independents have said they would vote against preventing floor debate on reform legislation, and negotiations on the Senate floor could produce a substantially different bill than that submitted this week to the Congressional Budget Office for a cost estimate.

Moderate Democrats have expressed concern about including a public option in reform legislation, and Sen. Joseph I. Lieberman (I-Conn.) has said he would oppose legislation with such a provision.

A provision in the Senate Health, Education, Labor and Pensions Committee measure to provide long-term care insurance also has come under fire from moderates. Seven centrist senators Oct. 23 wrote Senate Majority Leader Harry Reid (D-Nev.) asking him to remove the Community Living Assistance Services and Supports program from the melded bill that will go to the Senate floor because they said it would add to the federal deficit in its second 10 years and beyond.

“We have grave concerns that the real effect of the provisions would be to create a new federal entitlement program with larger, long-term spending increases that far exceed revenues,” the lawmakers said.

The letter was signed by Sens. Kent Conrad (D-N.D.), Blanche L. Lincoln (D-Ark.), Mary Landrieu (D-La.), Evan Bayh (D-Ind.), Mark R. Warner (D-Va.), Ben Nelson (D-Neb.), and Lieberman.

Prior to Senate floor debate, Reid is working to meld into one package separate health reform measures approved by the Senate HELP committee in July (S. 1679) and the Senate Finance Committee Oct. 13 (S. 1796).

More Details Coming.

Schumer, Brown, and Whitehouse told reporters the public option in the melded bill will negotiate payment rates with providers and not be based on Medicare payment rates; it will not need federal funds to be self-sustaining; and individuals will not receive additional federal subsidies to get insurance through a public option beyond what they would get for obtaining coverage from private insurers.

“As members learn the details of what’s in it, they’re going to see that it’s a true attempt to be a level playing field--not some covert way of getting single payer--and they are going to be very comfortable with it,” Schumer said.

Several Democrats have complained that they have not yet seen language of the public option that is in the bill, but Schumer said “letting it all out now doesn’t make much sense until you get a CBO score.”

Schumer said getting cost estimates back from CBO could take anywhere from four days to two weeks.

Republican, Business Group Opposition.

Senate Republicans meanwhile said Oct. 28 that a public option with a state opt-out provision would be an “illusion” because states would not opt out because they most likely would not be able to also reject fees or tax increases associated with reform legislation.

“It’s hard for me to conceive that in reality this will be a real choice for states,” Sen. Sen. Mike Johanns (R-Neb.) told reporters at a briefing. “In reality, it’s a false option.”

Senate Republican Conference Chairman Lamar Alexander (R-Tenn.) said Congress should adopt less sweeping reforms instead of those being put forth by Democrats, including allowing small businesses to form health insurance pools, allowing individuals to buy policies across state lines, and adopting medical malpractice reforms.

Meanwhile, an association of business leaders Oct. 28 argued against the inclusion of a public insurance option in the Senate health reform bill, saying it would ultimately shift costs to the private sector. Members of the Business Roundtable, an association of chief executive officers of leading U.S. companies, said in a conference call with reporters that Reid's decision to include a public option with a state opt-out is the wrong direction for health reform.

John Castellani, president of the Business Roundtable, said members of the association are concerned the public option will underpay providers, shifting costs to the private sector instead. Even with the public option projected to enroll only about 10 million people, Castellani said he expects the numbers to grow and exacerbate the cost shift.

Castellani also said the public option would stifle innovation in health care because it would provide no incentive to explore new technologies.

By Steve Teske

Copyright 2009, The Bureau of National Affairs, Inc.