‘Trigger’ could be set on healthcare


Looking to break the logjam on healthcare legislation, the White House and Democrats in the Senate are increasingly placing their hopes on the idea of a “trigger” that, if set off, would allow the government to offer health insurance to many Americans.

Under a trigger, private insurance companies would be told to meet benchmarks for improving the health system, such as insuring more Americans and reducing healthcare costs. If they failed to do so by a certain deadline, the federal government would launch its own health insurance program.

The plan might win over moderate Republican and wavering Democratic senators, who do not want to give the government blanket authorization to enter the insurance market and compete with private companies. At the same time, President Obama could make the argument that he has not abandoned the prospect of a government-run plan, also called a “public option,” which liberals contend is needed to inject competition into the insurance industry.


“This is the best shot we’ve got for getting a public option,” said one House Democratic advisor, who requested anonymity because he was not authorized to speak publicly. “It’s better than nothing.”

The proposal has become a central point in negotiations between Obama’s staff and Sen. Olympia J. Snowe of Maine, a moderate Republican.

If Snowe were to support a healthcare overhaul bill, she potentially could bring a patina of bipartisanship to the measure, providing political cover to other moderate Republicans and conservative Democrats who have withheld their support.

Talks between the White House and Snowe have focused on what would set off the trigger. For Obama, the challenge is to come up with benchmark numbers that would satisfy both moderate Republicans and liberal Democrats. A concern voiced by Republicans is that the bar would be set so high for private insurers that a government-run program would prove inevitable.

Suggestions that Obama might support a trigger were welcomed by the influential 52-member coalition of Blue Dog House Democrats -- conservatives who generally are not sold on the healthcare plans.

“The trigger is something the Blue Dogs have supported from the beginning,” said Brad Howard, spokesman for Rep. Mike Ross (D-Ark.), who heads the coalition’s healthcare task force. “We’ve been talking about this for a while as a compromise, as a middle-of-the-road and moderate alternative.”


Obama’s position is that a government-run plan is needed, but he has signaled that he is flexible on this front. Having invested so much political capital in the healthcare fight, he does not seem prepared to see the effort collapse because of wrangling over the public insurance option.

After returning from his Labor Day break at Camp David, Obama will strategize Tuesday at the White House with House Speaker Nancy Pelosi (D-San Francisco) and Senate Majority Leader Harry Reid (D-Nev.). Putting even more of his reputation at stake in the healthcare fight, the president will address a joint session of Congress the next day.

The White House declined to comment on the negotiations with Snowe.

Cobbling together enough votes to pass a healthcare bill is a tricky matter. Taking positions attractive to one bloc of lawmakers risks alienating another. Many Democrats say that they will not vote for a bill unless it creates the government-run program right away.

“I will support nothing short of a robust public health insurance plan upon implementation -- no triggers,” said Rep. Jan Schakowsky (D-Ill.). “I believe Congress will pass and the president will sign such a bill this fall.”

In an interview Thursday, Sen. Barbara Boxer (D-Calif.) cited the high salaries of health insurance executives and rising premiums as reasons for adopting a public plan without delay. Giving insurers a chance to prove themselves anew is a waste of time, she said.

“I support a public-interest option now because we already know the problem,” Boxer said.

She added: “We don’t need to test out the insurance companies. We’ve tested them out for years.”


Complicating matters even more for Obama is that some Democrats oppose his healthcare overhaul for reasons other than the public option. These members would probably not be swayed either way by a deal with Snowe.

Rep. Heath Shuler (D-N.C.), for example, worries that the bill moving through the House would not do enough to reduce healthcare costs. “He’s got many other concerns about the bill,” Shuler spokesman Doug Abrahms said.

Given that a trigger could scare off some Democratic votes in Congress, some lawmakers contend that negotiations on the idea are not worth the effort.

One Democratic senator, speaking on condition of anonymity because negotiations were ongoing, said that there were no guarantees that a trigger would create a 60-vote, filibuster-proof majority in the Senate.

“We don’t even know what this buys us,” the senator said. “Does it get us to 58 votes? And if that’s all it does for us, why do we want to go down this route?”



Janet Hook in the Washington bureau contributed to this report.