Pelosi Regrouping After Count Questions Votes for ‘Robust’ Public Plan

On Thursday, House Speaker Nancy Pelosi (D-Calif.) said she remains hopeful that she will be able to introduce the House's final health care reform legislation next week, CQ Today reports.

Ideally, the House would pass its health care bill by Thanksgiving, and President Obama would sign combined Senate-House legislation into law before Christmas, Pelosi said (Wayne/Epstein, CQ Today, 10/22).

However, aides caution that a new whip count showing insufficient support for a "robust" public health insurance option among moderate Democrats could delay that timeline, according to Politico.

Plans to unveil the House bill at a ceremony at the Capitol on Tuesday or Wednesday next week now might be postponed, the aides said (Allen, Politico, 10/23).

Earlier this week, some Democrats seemed certain that the robust option would attract the 218 votes needed for passage (California Healthline [1], 10/22). But after counting votes on Thursday night, Pelosi determined that the robust option lacks sufficient support for inclusion in the final House bill (Politico, 10/23).

The whip count Pelosi called for earlier this week found 46 Democrats who said they would oppose a robust option. Given House Republicans' almost universal opposition to any public option, Democrats could lose no more than 39 Democratic votes to pass the bill (Soraghan, The Hill, 10/22).

The House has been weighing three versions of the public option. The robust option, favored by liberals, which links reimbursement fees for physicians to Medicare reimbursement rates plus 5%.

Moderates prefer a public option that allows doctors to negotiate rates directly with the government. A compromise plan would establish a system of negotiated rates, but includes a trigger to the Medicare-plus-5% plan if negotiated rates fail to generate sufficient savings (American Health Line [1], 10/22).

Increasing Likelihood That Bill Will Contain Compromise Plan

The compromise plan now seems more likely to be the version included in the House bill.

Administration officials say that Obama expressed support for the trigger plan during a meeting with Pelosi on Thursday, Politico reports. The move away from the robust option could attract more moderate Democrats from conservative-leaning districts (Politico, 10/23).

Pelosi reiterated her pledge to include some form of a public option in the House's bill and did not insist on the Medicare-plus-5% plan on Thursday. But she criticized the negotiated plan as more expensive than the robust option and said that it would exceed the $900 billion limit Obama has set for the cost of health reform (The Hill, 10/22).

In a sign that she has not yet abandoned hope for the robust option, during a meeting on Thursday night, Pelosi called on progressive Democrats to drum up support for the Medicare-plus-5% plan.

After the meeting, Rep. Jerrold Nadler (D-N.Y.) said, "They want us to persuade everyone we can persuade." Pelosi also is expected to make an aggressive appeal to lawmakers in support of the robust plan during a caucus meeting Friday (O'Connor, "Live Pulse," Politico, 10/22).

Pelosi Says House Bill Will Include Repeal of Antitrust Exemption for Insurers

For the first time on Thursday, Pelosi said that the House reform bill (HR 3200) would include a provision that eliminates the health insurance industry's exemption from federal antitrust laws, CQ Today reports.

The Senate is weighing a similar repeal (S 1681) of the industry's antitrust exemption that was introduced by Judiciary Committee Chair Patrick Leahy (D-Vt.). Leahy has said that he supports including the repeal in the Senate's health care overhaul bill (Epstein, CQ Today, 10/22).

The House Judiciary Committee earlier this week voted to approve a bill (HR 3596) that would partially repeal the 60-year-old antitrust exemption (California Healthline [2], 10/22).

That bill, sponsored by committee Chair John Conyers (D-Mich.), would enable the federal government to prosecute insurers if they engage in price-fixing, bid-rigging or market allocations (Epstein, CQ Today, 10/22).

36 Democrats Threaten To Vote 'No' on Health Bill Because of Costs

Thirty-six Democrats sent a letter to Pelosi and House Majority Leader Steny Hoyer (D-Md.) stating that they will withhold their support for the House's reform bill unless it sufficiently cuts health care costs, CongressDaily reports.

The letter was written by Democratic Reps. John Barrow (Ga.) and Glenn Nye (Va.), and most of the legislators who signed the letter are members of the fiscally conservative Blue Dog Coalition.

Signatories say that their support for the bill hinges on whether Congressional Budget Office projections for the cost of the final bill show that it significantly cuts long-term costs.

A House Democratic leader said that party leadership is working to convince some of the signatories that the legislation would meet their cost-cutting goals (Hunt/House, CongressDaily, 10/23).

The letter states, "CBO Director Douglas Elmendorf has already indicated that the bill being considered by the House does nothing to rein in the cost of health care and therefore may not be sustainable outside the 10-year budget window. We will be unable to support any health care legislation that doesn't meet the president's goals of driving down and holding down the cost of health care, as determined by CBO" (Dennis/Newmyer, Roll Call, 10/22).