Despite months of outward ambivalence about creating a government health insurance plan, the Obama White House has launched a behind-the-scenes campaign to get divided Senate Democrats to take up some version of the idea for a final vote in the coming weeks.
President Obama has cited a preference for the so-called public option. But faced with intense criticism over the summer, he strategically expressed openness to health cooperatives and other ways to offer consumers potentially more affordable alternatives to private health plans.
In the last week, however, senior administration officials have been holding private meetings almost daily at the Capitol with senior Democratic staff to discuss ways to include a version of the public plan in the healthcare bill that Senate Majority Leader Harry Reid (D-Nev.) plans to bring to the Senate floor this month, according to senior Democratic congressional aides.
Among those regularly in the meetings are Obama’s top healthcare advisor, Nancy-Ann DeParle; aides to Reid; and staff from the Senate Finance and Health committees, both of which developed healthcare bills.
The measure that goes to the floor will be an amalgam of the two committees’ bills, put together by Reid and key Democrats. The health committee bill contains a national government plan; the finance committee version does not.
Obama has also been reaching out personally to rank-and-file Senate Democrats, telephoning more than a dozen in the last week to press for action.
The White House initiative, unfolding largely out of public view, follows months in which the president appeared to defer to senior lawmakers on Capitol Hill as they labored to put together gargantuan healthcare bills.
It also marks a crucial test of Obama’s command of the inside game in Washington in which deals are struck behind closed doors and wavering lawmakers are cajoled and pressured into supporting major legislation.
The challenge is to go to the Senate floor and hold the deal, said Steve Elmendorf, a lobbyist who served as chief of staff to former House Democratic leader Dick Gephardt. “They are more involved than people think,” he said. “They have a plan and a strategy, and they know what they want to get, and they work with people to get it.”
With the Senate Finance Committee wrapping up work on its legislation and moving toward a formal committee vote this week, senior Democrats in the House and Senate are furiously working on detailed compromises to ensure enough votes to pass healthcare bills out of the two chambers later this month.
Although on paper Democrats hold majorities in both houses, nailing down those majorities has not been easy -- particularly in the Senate, where Democrats need a 60-vote supermajority to head off a Republican filibuster. The party commands a 60-to-40 majority, including two independents, but several centrist Democrats have expressed reservations about parts of Obama’s healthcare agenda.
No issue has proved more divisive than the proposal to create a national insurance plan, to be operated by the federal government and offered to some consumers as an alternative to private insurance.
Though favored by liberals as the best way to protect consumers from high premiums charged by commercial insurers, a government plan is still viewed with wariness or hostility by many conservative Democratic lawmakers and nearly all Republicans.
Just last week, two proposals to create a national government plan were defeated in the finance committee when Republicans and conservative Democrats voted against them.
Those votes were viewed by some as the death knell of the public option, but the White House and its congressional allies are under heavy pressure from the Democratic Party’s liberal base to breathe life back into it.
That has Democratic leaders looking for ways to insert some form of the concept into a Senate bill without jeopardizing centrist support.
To that end, Obama is lavishing attention on moderate lawmakers while he continues to talk up the public option.
He has met repeatedly in private with Sen. Olympia J. Snowe (R-Maine), who has floated a “trigger” proposal that would allow states to set up government plans as a fallback if commercial insurers did not control premiums.
The president has also personally discussed healthcare at least three times recently with Sen. Ben Nelson (D-Neb.), one of the most outspoken Democratic critics of the public option.
When Obama spoke by phone with Sen. Maria Cantwell (D-Wash.) last week, he made a point of the breadth of support for the public option, she said in an interview. Cantwell authored a proposal to let states set up public plans, which Democrats added to the Senate Finance Committee bill on Wednesday.
And when Pennsylvania Democrats came to the White House recently to celebrate the Pittsburgh Penguins’ Stanley Cup win, Obama pulled some of them aside and reiterated his commitment to the public option even as Baucus was preparing a bill without one.
Democratic leaders on Capitol Hill are also laboring to reverse the impression that the public option is a politically risky vote for conservative Democrats.
New York Sen. Charles E. Schumer, the chamber’s third-ranking Democrat, has been canvassing centrist Democrats to explore ways they might support a new government plan.
“I have talked to every one of our conservative members and they are open to some kind of public option,” he told reporters last week.
And at a closed-door meeting of Senate Democrats on Tuesday, Assistant Majority Leader Richard J. Durbin (D-Ill.) marshaled polling data from districts represented by conservative Democrats that showed a majority would back the requirement that Americans get health insurance so long as there was a public option.
“To argue that this is some fringe position is to ignore the obvious,” Durbin said.
The nonprofit Kaiser Family Foundation’s September healthcare survey showed 57% of Americans support the creation of a “public health insurance option similar to Medicare,” down just two percentage points from the August and July surveys.
Those polls have also been followed closely at the White House.
By including a plan in the bill that the full Senate will debate, the White House and Democratic congressional leaders could force Republicans to try to remove it.
“One of the most consistently popular ideas in the healthcare debate is the public option, more popular than health reform generally,” said Paul Begala, a veteran Democratic strategist and former senior aide to President Clinton. “It’s good politics.”
But Obama and Reid are treading carefully, wary of including a provision that would scare off moderates such as Snowe, Nelson and Blanche Lincoln (D-Ark.), who have all indicated they would not support a national public plan.
Besides Snowe’s trigger approach and Cantwell’s proposal, an alternative is being considered from Sen. Thomas R. Carper (D-Del.) that would also give states flexibility to set up their own public plans.
The White House remains sensitive about being viewed as dictating what lawmakers should do.
Last week, DeParle and National Economic Council Director Larry Summers told a group of House Democratic leaders that the president is still open-minded about options, according to one Democratic aide.
“You get a lot of resentment when the White House comes in to do Congress’ job,” said Dan Meyer, a lobbyist who served as President George W. Bush’s last legislative affairs chief and was a longtime senior aide to House GOP leaders.
Peter Nicholas of the Washington bureau contributed to this report.