WASHINGTON -- A handful of moderate Senate Democrats will determine the fate of this year's health care overhaul, and they're sending strong signals that while they're willing to compromise, they're wary of a strong public option.
"I've ruled out a government-funded and a government-operated plan," said Sen. Blanche Lincoln, D-Ark., who faces a tough re-election fight next year. Added Sen. Mary Landrieu, D-La. "I don't believe Americans want a (new) government-run health care system."
Democrats control 60 of the 100 Senate seats, enough to overcome procedural hurdles if they stick together. But they've been struggling to find consensus, because moderate senators, most from the South and Midwest, hear lots of skepticism from the folks back home.
The informal centrist roster includes senators who have broken with the party the most this year -- Indiana's Evan Bayh and Nebraska's Ben Nelson -- as well as Tom Carper of Delaware, Joseph Lieberman of Connecticut (an independent who caucuses with the Democrats), Mark Pryor of Arkansas, Mark Warner and Jim Webb of Virginia, Jon Tester of Montana and Kent Conrad and Byron Dorgan of North Dakota.
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Nelson and Sen. Olympia Snowe of Maine, the lone Republican to vote for a Democratic-authored health care plan in the Senate Finance Committee earlier this month, hosted meetings Tuesday and Thursday with a small group of moderates, including Sen. Susan Collins, R-Maine. Some centrists have had lengthy, private meetings with President Barack Obama at the White House.
Their chief messages: Constituents are confused and wary of changes to the nation's health care system, and if a plan is perceived as too expensive and complex, there could be political consequences.
"We need to make constituents understand what we're doing. We need a tutorial," said Snowe.
The moderates, though, are up against powerful political forces. Democratic leaders in the House of Representatives have pledged to include a strong public option in their bill, which is expected to be debated next month. In the Senate, Health Committee Chairman Tom Harkin, D-Iowa, estimates that a strong public option has at least 52 Democratic votes.
Leaders talk of pushing a public option that would allow states to "opt out," but that's not generating enthusiasm among the moderates.
Polls illustrate why both the leaders and the skeptics think their positions are strong. A Pew Research Center survey conducted Sept. 30 to Oct. 4 found 55 percent of respondents preferred a government-run plan.
But the poll also found 47 percent opposed to health care proposals being discussed in Congress, compared to 34 percent supporting them.
People like the concept of a public option but are more tentative about details of a comprehensive package -- especially one they don't yet know, said Carroll Doherty, the poll's associate director.
In states where voters are more conservative, health care change is emblematic of something bigger, something analysts say could hurt those states' Democrats in next year's mid-term congressional elections. Thirty-eight Senate seats are up next year; each party now holds 19 of those.
In more conservative areas, "the mood we're seeing out there is not just being driven by health care, though health care may be the tipping point," said Jennifer Duffy, senior editor for the Cook Political Report. "People are unhappy about deficits, bailouts, and just see too much government."
The Arkansas Poll this week made that point. Of 381 adults it surveyed in that state, 43 percent said that if the health care system changes, the quality of care would get worse, while 15 percent said it would improve. Thirty-one percent said it would stay the same.
Asked if they backed a government-run plan to compete with the private sector, 40 percent said yes while 45 percent said no.
"Arkansans remain unsold on the need for change," said poll director Janine Parry. And Sen. Lincoln, up for re-election next year, will be running in a state where Obama won only 38.8 percent of the 2008 vote.
Voters also see the federal deficit, which hit a record $1.4 trillion in fiscal 2009, as a symptom of out-of-control government. That concern was apparent this week when 12 Democrats and Lieberman defied the party line and voted against cutting off debate on a plan to stabilize Medicare doctors' fees.
The $247 billion, 10-year proposal would have increased the deficit, and moderates rebelled. The cost "is not an insignificant amount of money, and the Senate should be up front about the true costs of health care reform," said Dorgan, who faces re-election next year.
Where, these moderates ask, will Washington find the money to fund health care? The Senate Finance version is estimated to cost $829 billion, and part of the cost would come from taxing high-end insurance policies, a tax that Nelson found his constituents fear will be passed on to them.
"One question that keeps getting asked by constituents is, 'If you're going to tax insurers, won't that add to our costs?'" he asked.
Despite all the anguish, the moderates won't rule out some sort of compromise; after all, they note, health care legislation is likely to be so all-inclusive that no one will be completely satisfied.
Conrad suggests that he could entertain a public option if the new plan would allow health care providers to negotiate rates, rather than rely on Medicare, whose reimbursement levels, he says, hurt his state. Bayh, who is up for re-election next year, said after meeting with Obama recently that "the primary focus for moderates is getting costs under control for middle-class families and small businesses, and passing fiscally responsible reform that reduces the federal deficit over time."
So far, though, common ground has been hard to find.
In the House, 52 members of the Blue Dog Coalition, a group of conservative Democrats, have reservations similar to those of moderate senators. Senate Majority Leader Harry Reid, D-Nev., has been negotiating with top Democrats all week to write compromise legislation, and they had hoped to finish this weekend.
That's now unlikely to happen, unless centrists are satisfied that they can go explain the bill at home; so far, that hasn't happened.
"In my mind, there is a compromise position," Landrieu said, "but I don't know what it is yet."
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