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Strong Public Option "Very Close," Pelosi Says

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House leadership is still hedging its bets on what version of the public option will make it into the unified House health reform bill, but Speaker Nancy Pelosi told reporters Thursday that Democrats are nearing the 218 votes needed to pass a strong public option tied to Medicare reimbursement rates.

"It's very close, it's very close," Pelosi said of majority support for the so-called "robust" public option, which she personally supports. She did not commit to getting the strong option into the bill, however. "We're in a good place, because we have many good options," she said.

On both counts, the Speaker's assessment seemed more optimistic than that of Progressive Caucus Co-Chair Raul Grijalva, who suggested to the Huffington Post that progressives might scuttle a bill that forces the public health exchange to negotiate its own reimbursement rates with insurers -- the policy favored by conservative Blue Dog Democrats. Grijalva estimated Wednesday that the strong public option had the support of 160 to 170 Democrats, a number significantly lower than the whip count his co-chair Lynn Woolsey has reportedly bandied about.

Though she declined to cite a precise number of supporters for the robust plan, Pelosi was confident enough to say that while the strong public option was only one of three public insurance exchanges the House has sent to the Congressional Budget Office for cost analysis, scores on the two weaker options -- both of which would require the new exchange to negotiate its own reimbursement rates -- were requested simply to give conservative Blue Dog Democrats another chance to make their case.

"In all fairness to those who believe that the negotiated rates work better for them in their district, we're trying to get from the Congressional Budget Office how we could have more savings out of negotiated rates," Pelosi said. The strong public option would save $110 billion over 10 years, she said, compared to $25 billion for an option with negotiated rates according to preliminary estimates. "That's a big difference."

For the first time since their 1995 inception, the Blue Dogs have found themselves out-organized by their liberal counterparts, and their commitment to decoupling the public option from Medicare has been slipping. While progressives have united behind a strong public option, conservative Democrats are concerned variously with addressing regional disparities in Medicare reimbursement, keeping the bill's final cost below $900 billion and waiting to see what the Senate does.

Bridging the gap in savings between the weaker and stronger public options won't be easy for Blue Dogs, and they won't like one possibility that Pelosi confirmed has been floated in a "very preliminary" form: a windfall profits tax on income for health insurers. "I have asked Chairman [Charlie] Rangel [D-N.Y.] to ask his staff to see what is in it for us," Pelosi said. "Let me say that I believe that all of the participants, whether it's insurance companies or the pharmaceutical industry, have much more they can put on the table to help reduce costs."

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