10/23/2009 05:12 am ET Updated May 25, 2011

Obama: Leaning Toward Limited "Regional" Public Option?

In a brief press conference aboard Air Force One Monday morning, White House Press Secretary Robert Gibbs seemed to hint at a new twist in the debate over whether a government-operated health insurance program, similar to Medicare but open to any citizen who wants to join it, will be one of the options available in any new health reform legislation.

Until now, the question has been whether the president will insist on such a "public option" (which he has said he prefers) or whether, instead, he will capitulate to the demands of conservative "Blue Dog" Democrats in Congress, one Republican senator (Olympia Snowe), and some advisors in his own administration by accepting either a public option "trigger" (activating the public option only if private insurers do not cut costs sufficiently over the next two or so years) or regional, non-governmental "co-ops."

Many progressives are coming to see public option as the litmus test for the president's commitment to honoring his campaign promises of relatively bold "change." Speaker Nancy Pelosi has declared that House Democrats will not support any bill lacking a "public option," and the House Progressive Caucus has threatened to vote against any reform bill that does not contain it. (The White House responded by indicating they need to be "good soldiers" and support any bill that emerges.)

A "regional public option" proposal was first circulated four days ago by House Majority Whip Jim Clyburn (D-SC), who earlier this year predicted that comprehensive health reform would not pass at all this year and proposed an "incremental" approach. Gibbs' comments Monday morning suggest that Obama may be planning to endorse Clyburn's "incrementalist" approach in a pivotal speech he is scheduled to give Wednesday.

A region-by-region public plan could be a compromise proposal, an effort to mollify progressives while stopping short of the the nationwide, open-to-all proposal that has caused stiff opposition from the insurance industry and conservative lawmakers. It is questionable whether a regional plan would mollify progressives, however. Regional groups would have less purchasing power, and thus less ability to reduce costs, than a nationwide plan would have, and other trial balloons that fall short of making the option universal, including triggers and regional co-ops, have not garnered much support.

The complete text of the portions of Gibbs' Q&A today concerning health care reform is set forth below:

Q: Yesterday you called the public option -- or said the president thinks the public option is a valuable tool. Same time, Mr. Baucus's committee doesn't have -- his draft bill doesn't have a public option in it. What are your thoughts on that?

MR. GIBBS: Well, I have not -- I mean, I've seen reports about a Finance Committee proposal. Obviously we'd be pleased if the Finance Committee, throughout the course of the next few days, came up with a proposal to -- that can get through their committee, hopefully with bipartisan support.

Q: Would you be displeased if they didn't?

MR. GIBBS: Well, look, we're in a process at this point where the President will speak on Wednesday, and as I also discussed yesterday, pull together the strands of many different pieces of legislation to come up with a plan that improves health care for all Americans.

The reason the president thinks it's a valuable tool -- and let me -- I'll try to explain this as I did yesterday. For 160 to 180 million Americans that get their insurance primarily through their employer, the public option will not in any way affect them. What we're talking about is the increased choice and competition that is needed in an individual -- in the individual and small business market that often is dominated in many areas and states in the country with only one insurance carrier.

The story I used yesterday was a friend of mine who lives in Alabama who started a small business. One of the first things he had to do was go out and get insurance for he and his family. And he's lucky. His family is healthy. And 89 percent of the market in Alabama, the individual market, is controlled by Blue Cross and Blue Shield -- one insurance company.

He was lucky. But he's talked to a lot of friends, other people in small business, that have started small businesses or that are working in small businesses, that haven't been as lucky; they were denied coverage. He understands, my friend does, that if somebody in his family gets sick or for some reason if he loses his insurance, he's going to have a very hard time covering his family.

For markets where that is the case, having an option, government option, public option, that provides increased choice and competition and that provides a check on insurance companies, the President continues to believe is an important part of this proposal.


Q: Is the President asking the union leaders not to draw lines in the sand about the public option?

MR. GIBBS: Again, the President thinks it's a very valuable tool. I think the President thinks we have to have choice and competition. So I think we're -- we all understand the importance of getting health care reform done quickly and getting it done this year.