"Senior Senate Democrats at work with White House officials on health care legislation are strongly considering a requirement for the federal government to sell insurance in direct competition with private industry, officials said Thursday, with individual states permitted to drop out of the system.
Liberals in Congress long have viewed such an approach, called a public option, as an essential ingredient of the effort to overhaul the nation's health care system, and President Barack Obama has said frequently he favors it. But he has also made clear it is not essential to the legislation he seeks, a gesture to Democratic moderates who have opposed it.
Democratic moderates are skeptical of allowing the government to sell insurance, concerned that it would mark an unwarranted federal intrusion into the private marketplace. And even if they agreed, it would raise questions of payment rates for doctors, hospitals and other providers.
Kent Conrad, D-N.D, for example, has said repeatedly he could not accept a plan with payments tied to Medicare, the federal health care program for the elderly, because rates in North Dakota are too low to give doctors an incentive to treat additional patients.
Moderate Republican Sen. Olympia Snowe, who also has met regularly with administration officials, called the emerging proposal "just another public option."
"I do not support it," she said.
Snowe went one step further and warned that any inclusion of this "opt out" measure would cause her to withhold her support from proceeding to the bill.
Her "no" vote alone would not be enough to stop the bill from moving forward. But in what could be an ominous sign for Reid, Sens. Ben Nelson, D-Neb., called the "opt out" public plan a "difficult option" and questioned how difficult it would be for states to opt out."
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