Another GOP senator open to health care overhaul

WASHINGTON – A second Republican senator signaled Wednesday she's open to voting for sweeping health care legislation this year, putting President Barack Obama closer to a historic achievement that has eluded generations of Democratic leaders.

But Sen. Susan Collins, R-Maine, told The Associated Press that the bill approved Tuesday by the Finance Committee needs substantial improvements to make coverage more affordable, contain costs, and protect Medicare. Nevertheless, she joined her Maine GOP colleague Sen. Olympia Snowe in endorsing the goal of far-reaching changes.

"My hope is we that can fix the flaws in the bill and come together with a truly bipartisan bill that could garner widespread support," Collins said in an interview. "I think this bill is far superior to the ones passed by the Senate (health) committee and the three House committees, but it needs substantial additional work."

The 10-year, $829 billion Finance bill was approved by the committee Tuesday on a 14-9 vote, after Snowe broke ranks with her Republican colleagues to support Chairman Max Baucus' middle-of-the-road plan.

Wednesday, Snowe tackled the most divisive issue still on the table: creation of a government insurance plan that would compete with private ones.

While emphasizing that she still opposes the so-called public option, Snowe said in a nationally broadcast interview that she could foresee a government-run plan that would "kick in" if private insurers failed to live up to expectations that they keep premiums in check.

"I think the government would have a disproportionate advantage" in the event of a government-run option, Snowe acknowledged. At the same time, she added, "I want to make sure the insurance industry performs, and that's why we eliminate many egregious practices."

If the industry didn't follow through on congressionally-mandated changes aimed at making health care more affordable, she said, "then you could have the public option kick in immediately."

Snowe previously had proposed using the public option as an incentive, or a threat, to private insurers. This "trigger" option, or some version of it, has survived the bitter debate and scrutiny to remain a viable option for compromise.

Such a statement from a Republican can be very influential in an environment in which GOP lawmakers almost universally have opposed any kind of government-run health care option to compete with private insurers. It represents a break in party solidarity, even if finite. Health care proposals advanced in the House include such a government option.

Snowe broached her standby notion again as talks among lawmakers on health care were going back behind closed doors; Senate leaders are trying to merge two very different bills into a new version that can get the 60 votes needed to guarantee passage.

Collins, however, said she could not support Snowe's idea because she thinks it would make it too easy for a Democratic administration to impose a government plan nationwide. "It would simply delay the public plan for a couple of years," she told AP.

The White House dispatched chief of staff Rahm Emanuel, Office of Management and Budget Director Peter Orszag and other top advisers to Capitol Hill for afternoon meetings on combining the bills.

House Majority Leader Steny Hoyer, D-Md., told reporters that it was unlikely that the House would vote before the first week of November. He said he expected a vote by Christmas but was making no guarantees.

Senate Majority Leader Harry Reid, D-Nev., has said he wants move quickly to merge the Finance bill with a version passed earlier by the Senate health committee. His goal is to get health care overhaul legislation onto the floor the week after next.

Both bills were written by Democrats, but that's not going to make it easier for Reid. They share a common goal, which is to provide all Americans with access to affordable health insurance, but they differ on how to accomplish it.

The Finance Committee bill that was approved Tuesday has no government-sponsored insurance plan and no requirement on employers that they must offer coverage. It relies instead on a requirement that all Americans obtain insurance.

The Senate Health, Education, Labor and Pensions Committee bill, passed earlier by a panel in which liberals predominate, calls for both a government plan to compete with private insurers and a mandate that employers help cover their workers. Those are only two of dozens of differences.

In general, bills moving toward floor votes in both houses would require most Americans to purchase insurance, provide federal subsidies to help those of lower incomes afford coverage and give small businesses help in defraying the cost of coverage for their workers.

The measures would, among other things, bar insurance companies from denying coverage on the basis of pre-existing medical conditions and for the first time limit their ability to charge higher premiums on the basis of age or family size. Expanded coverage would be paid for by cutting hundreds of billions of dollars from future Medicare payments to health care providers. Each house also envisions higher taxes — an income tax surcharge on million-dollar wage-earners in the case of the House, and a new excise levy on insurance companies selling high-cost policies in the Senate Finance Committee bill.