Senate Finance Committee Chairman Max Baucus and other Democratic leaders are targeting more than a dozen moderate and conservative Republicans as they pursue a bipartisan deal to extend health care coverage to nearly 46 million uninsured Americans.
Baucus signaled his willingness yesterday to compromise on a controversial provision of President Obama's health care overhaul plan in a bid to attract enough GOP support to pass the legislation in the Senate this summer with as many as 70 votes.
The Montana Democrat emerged from a morning session with key Republicans and Democrats saying he was "inclined toward" jettisoning a proposed government-sponsored insurance program endorsed last week by Obama in favor of a new proposal to create national, state and regional health care insurance cooperatives.
Republicans bitterly oppose the public insurance option, saying it would undermine the private insurance industry and lead to a national health insurance system. Some conservative Democrats also are skeptical of the public plan option, even as they and Baucus support Obama's overall reform goals.
High on the list of Senate Republicans being wooed: Charles Grassley, Iowa, the ranking Republican on the Finance Committee who has publicly denounced a government-run insurance plan; Olympia Snowe, Maine, the only Republican who withheld her name from a recent GOP letter blistering Obama's support for the public plan; Pat Roberts of Kansas, and Mike Enzi of Wyoming, a Finance Committee member and the ranking Republican on the Health, Education, Labor and Pensions Committee who has signaled the potential for a deal despite his recent sharp criticism of the Democrats' handling of the legislation.
Other Republican senators coveted by Democrats are Susan Collins of Maine, Mike Crapo of Idaho, Orrin Hatch of Utah, Lisa Murkowski of Alaska and Lamar Alexander of Tennessee, a prominent southern moderate. Murkowski and Alexander are on the Health, Education, Labor and Pensions Committee, which with the Finance Committee is responsible for drafting Senate legislation. Hatch, who is on both committees, is also a close friend of Sen. Edward Kennedy, D. Mass., chairman of the HELP panel.
Others on the list appear less probable converts, among them Nevada conservative John Ensign; John McCain of Arizona, who Obama criticized during last year's presidential campaign for proposing to eliminate the tax exclusion on employer-provided health insurance; and Bob Corker of Tennessee, a conservative freshman who has shown a strong interest in health care discussions although he doesn't belong to a committee with jurisdiction.
Baucus said that the public plan option is "so opposed at this point by Republicans" that "it's basically the question of, well, gee, what do we have to do to compromise to get health care passed this year?"
While he expressed interest in the co-op idea drafted by House Budget Committee Chairman Kent Conrad, D-N.D., he cautioned that it had to achieve many of the same goals as the public option, including being national in scope, having adequate upfront capital, offering the public a wide choice of affordable insurance and making sure it isn't eventually absorbed by the private insurance industry.
"It's not so much the favorite [plan], but it's the most talked about right now," Baucus said. "There are still a lot of questions."
Baucus and Grassley, his long-time ally on the Finance Committee, have frequently asserted that a straight party-line vote would tarnish the legislation and undermine efforts to gain broad national acceptance of the new health care changes. Baucus has regularly convened a meeting of the chairmen and ranking Republicans on the finance, health and labor, and budget committees, and has met frequently with rank and file Republicans in a search for common ground.
"We do think there is a good number of Republicans who want to be with the thing that passes," said a senior Democratic aide close to the negotiations. "Getting a bill approaching 70 votes is the most practical and durable way of getting things done."
Snowe and Collins vote frequently with Democrats and are being aggressively wooed by Baucus and other Democratic leaders. Both women have strong knowledge of the health care system and have been major players in previous health care debates, including creation of the Medicare prescription drug benefit and the recent expansion of the Children's Health Insurance Program (CHIP).
"I really sense a genuine desire in the [Finance] committee to achieve a bipartisan initiative," Snowe said yesterday.
If Baucus' version of the legislation can at the very least preserve or even increase Medicare payment rates to doctors and hospitals in rural areas he may win the support of Roberts, a member of the Finance Committee and co-chairman of the Senate Rural Health Care Caucus.
"There are a lot members of the [Finance] committee who would like to be for something, including me, but I'm not going to be for riding into a box canyon with our rural health care delivery health system," Roberts said in an interview earlier this month. "I'm going turn the horse around and say 'Hey wait a minute. Let's at least preserve what we have and work from there.'"
Murkowski has also complained that low Medicare reimbursement rates have hurt the ability of Alaskan Medicare beneficiaries to find doctors willing to see them. Addressing that issue may make her more open to the Democrats' plan.
While he has sharply criticized the Democrats' health plan, Enzi's past work with Kennedy has shown he is willing to compromise.
The Democrats will have no trouble passing a health care bill in the House, where they hold a 256 to 178 majority, but it could be more problematic in the Senate without some Republican votes. The Democrats currently control 59 of the 100 seats in the Senate, and could get up to 60 if Democrat Al Franken of Minnesota is finally seated. A minimum of 60 votes is needed to overcome the threat of a filibuster, but the Democrats cannot necessarily count on all of its members to back the legislation.
Republicans appeared disorganized early in the health care debate, but are beginning to galvanize around a set of objections to the legislation as Democratic committee leaders in the Senate and House have begun to circulate a series of proposals in anticipation of legislative markups, beginning next week in the HELP Committee and later this month in Finance.
Senate Minority Leader Mitch McConnell, R-Ky., and other Republican leaders are using talking points suggested by Republican strategist Frank Luntz in a detailed memo that condemns the Democratic plans as a "government takeover" similar to what's happening in the banking and auto industries.
"We want health care reform this year," said Alexander. "But the president set out objectives that we don't believe are good policy. Any government-run insurance option that has the effect of running out all the other choices and amounting to a Washington takeover of health care is a non-starter."
Some Republicans fret about alienating voters, with election campaigns looming next year, by challenging Obama on the most important health care legislation since the 1960s. But others argue that the White House and Democrats are moving too quickly to try to pass a complicated and costly bill without fully consulting with the GOP or fully understanding all the implications of the complex legislation.
Enzi noted yesterday that Kennedy, who is being treated for brain cancer, only gave the reins of his committee to Sen. Chris Dodd, D-Conn., 10 days ago, and yet the committee will begin action on the bill next week. "Sen. Dodd has been working diligently and talking to me daily to try to make some progress," he said. "But again, it's a short time frame. So compressed it's difficult to operate, let alone make sure everyone's ideas are in there."
Sen. John Cornyn, R-Tex., a member of the GOP leadership, said his members are alarmed by what they view as internal competition between Baucus and Kennedy and the fast-track schedule for acting on the enormously complicated and expensive overhaul.
"The idea we would do it this summer - on something so massive and complex and this difficult -- is more than a little daunting and almost scary," he said.
Roberts painted a somewhat different picture: "The bridge of cooperation has washed out. We can swim and we are willing to swim but health care is on the other side."
By Eric Pianin and Mary Agnes Carey, The Henry J. Kaiser Family Foundation
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.