Democratic rhetoric shifts on health plan

Some Senate Democrats who once demanded that a healthcare overhaul include a strong public option are retreating from that stance and appear willing to accept alternative proposals.

Among them is Sen. Debbie Stabenow, D-Mich., who said she is reviewing the latest weaker public option alternative to see whether it would offer acceptable competition with private insurers.

"The critical issue is not what we call something; it's the end result," Stabenow said on Monday. "What's driving all our healthcare discussions is to make sure people have insurance."

Stabenow's comments came as moderate and liberal Democrats continue to try to forge a public option compromise.

The latest proposal under discussion would create a national plan modeled after the federal employee health benefits program. Under the program, the Office of Personnel Management negotiates with private insurers and limits the companies' profit margins. The group plans to meet again on Monday.

Senate Majority Leader Harry Reid, D-Nev., said on Monday he does not expect the Senate to meet late Monday because of the White House holiday party for lawmakers. He does expect late nights the rest of the week and weekend work.

The OPM-run idea is based on a small business health program drafted by Democratic Sens. Blanche Lincoln and Mark Pryor of Arkansas and GOP Sen. Olympia Snowe of Maine. Snowe is the most likely Republican to vote for the bill as Democrats woo her support.

Snowe said on Sunday she has other concerns on affordability. A key factor for her will be a CBO analysis she requested on "numerous issues regarding premium increases and what exactly would be the affordable choices available to small businesses on the exchange."

"We need to know what is the lowest-cost, minimum actuarial value plan that will be available to small businesses," Snowe said. "That's crucial in terms of affordability. It's not enough to just have minimum reductions in premiums for small businesses. After all, this whole plan is designed around the notion of ensuring that small businesses have access to affordable choices."

She also asked which provisions in the bill would contribute to the rise of prices of premiums before the exchanges created in the bill start up in 2014.

She said she submitted the letter last week and hopes for results soon.

Snowe's support is crucial, given that Sen. Ben Nelson, D-Neb., has said he will not vote for the measure unless it includes more restrictive House language prohibiting federal abortion funding. The amendment Nelson introduced on Monday mirrors the House language, but it is not expected to pass when senators vote, which could happen as early as Tuesday.

Nelson also is a member of the group negotiating the public option compromise. He said Sunday night governors also could expand their state employee benefit programs instead of handing to OPM the administration of a national plan. Nelson has pushed for a state-based rather than national approach.

Stabenow and Sens. Mark Begich, D-Alaska, and Jeff Merkley, D-Ore., attempted to steer the debate away from the public option Monday and talk about a "healthcare bill of rights," essentially a check sheet of seven insurance industry improvements the bill makes.

The idea, Begich said, is to tell people "what they get in a basic and simple form."

Those changes include a ban on insurance companies discriminating against pre-existing conditions or dropping people because they get sick; a prohibition of co-payments for preventive services; and the ability of young people to stay on their parents' insurance until they are 26 years old.

These changes do not all fully kick in until the exchanges are up and running in 2014, but Merkley said a high-risk insurance pool will be immediately created to allow those with pre-existing conditions to get coverage.

Dan Friedman contributed to this report.