Media reports noted that, as Senate Majority Leader Harry Reid (D-NV) prepares a bill for the Senate floor, he is expected to include a version of the public option in the legislation. The expectation that Sen. Reid will do so is seen as an indication of increased liberal pressure and that public opinion appears to be moving towards support for a public option.

Politico (10/23, Brown) reports that senators said on Thursday that Reid "is leaning toward putting a public insurance option in the Senate health reform bill -- a signal that Reid increasingly believes he can get the votes needed for a plan that would allow states to opt out of the program." But "an Administration official" said President Obama "stopped short of endorsing the approach during a hastily called meeting Thursday with the Senate Democratic leadership at the White House." Instead, "one Democratic source said Obama appeared to prefer a 'trigger' option put forth by Sen. Olympia Snowe (R-ME), who has proposed allowing states to join a national insurance plan if affordable coverage was not widely available."

The AP (10/23, Espo) reports that "senior Senate Democrats at work with White House officials on healthcare legislation are strongly considering a requirement for" a public option "with individual states permitted to drop out of the system." Sens. Ben Nelson (D-NE) and Kent Conrad (D-ND) "said in separate interviews they had been told the plan was drawing interest in the private negotiations unfolding in an ornate room in the Capitol down the hall from the Senate chamber." The Senate negotiations "have proceeded in unusual secrecy, attended by Reid, two Senate committee chairmen, Sens. Max Baucus (D-MT) and Christopher Dodd (D-CT), and a small group of administration officials led by White House Chief of Staff Rahm Emanuel."

In a front page story, the New York Times (10/23, A1, Pear, Herszenhorn) reports that Reid's "latest thinking seemed to reflect a calculated gamble that the 60 members of his caucus could be persuaded to vote for the public plan, if it included some mechanism for states to opt out." Reid's "outlook was shaped, in part, by opinion polls showing public support for a government insurance plan, which would compete with private insurers." But as "word of Mr. Reid's intention spread Thursday, centrist senators from both parties said they had formed an informal group to resist creation of a uniform nationwide public insurance program."

The Washington Post (10/23, Montgomery, Murray) reports that Senate liberals, "led by Sen. Charles E. Schumer (D-NY), are seeking support for an 'opt-out' provision that would create a government plan but allow states not to participate." Sen. Olympia J. Snowe (ME), "the only Republican to support any of the Democrat-sponsored healthcare legislation, opposes the Schumer alternative and told reporters Thursday that she would vote against a measure that includes it." The Wall Street Journal (10/23, Hitt, Adamy, subscription required) also reports on Reid's plan to back a bill with a public option and state opt-out, noting Sen. Schumer's influence.

House Democrats "coalescing around" robust public option. The Washington Post (10/23, Montgomery, Murray) reports House Democrats "are coalescing around an $871 billion healthcare package that would create a government-run insurance plan to help millions of Americans afford coverage, raise taxes on the nation's richest families and impose an array of new regulations on private insurers, in part by stripping the industry of its long-standing exemption from federal antitrust laws." Speaker Nancy Pelosi "and her top lieutenants said Thursday that they are close to corralling the 218 votes they need to move forward with comprehensive legislation that would include a version of the public option prized by liberals as a fundamental pillar of reform." The Washington Times (10/23, Haberkorn, Rowland) reports conservative Democrats "in the House warned that they are concerned about other provisions in the plan, namely cost and taxes."

Snowe reiterates opposition to public option. Bloomberg News (10/23, Jensen, Dodge) reports that Sen. Olympia Snowe (R-ME) "said she won't support the immediate creation of any government-run insurance program and raised the possibility that legislation overhauling the health system won't be completed this year." In an interview on "Political Capital With Al Hunt," Snowe said, "A public option at the forefront really does put the government in a disproportionate position with respect to the industry." Bloomberg adds that while Snowe "said she doesn't like to use the term 'dealbreakers,' she said she opposes it, preferring a plan that would trigger a public option only if there isn't enough competition for private insurers to keep rates low."

Health insurers say they remain committed to reform.

The AP (10/23, Fram) reports health insurers "insist they're still committed to getting a healthcare overhaul bill passed this year. But all around Washington, people are wondering if -- or when -- the industry will change its mind and try to kill it." At a gathering of the industry group America's Health Insurance Plans, chief lobbyist Karen Ignagni said "insurers 'can continue to make a major contribution' to the overhaul effort." But her "comments came in the midst of mounting tensions between her industry and majority Democrats and on the heels of months in which President Barack Obama and Democratic leaders have painted insurers as a chief villain in the health overhaul effort."

Public option supporters protest health insurance industry conference. USA Today (10/23, Gaudiano) reports that "hundreds of people" protested "the private health insurance industry outside the same hotel where the industry's trade group, America's Health Insurance Plans, was holding a conference. The event was organized by Health Care for America Now, a group that supports a government-run 'public' health insurance option as part of healthcare reform." Robert Zirkelbach, "a spokesman for AHIP, said the industry is focused on covering everyone, improving quality and making healthcare coverage more affordable."

USAToday maintains young people should not subsidize older workers' health insurance.

In an editorial, USA Today (10/23) says that AARP and other consumer advocates would like it "if insurance companies were barred from charging premiums differentiated by age." But, USA Today argues that "young people should subsidize older workers little, if at all. The young have already been handed crippling government debts and obligations, driven largely by retiree benefit programs such as Medicare and Social Security. ... It would be unfair to order them to shoulder the burden of supporting near-retirees as well." The paper adds, "To work, the current health reform proposal needs wide participation. Young people are among the most likely to forgo coverage now. If Congress makes the price too high, and if it also makes the penalty for not buying insurance too light, they may opt out in droves -- defeating the purpose of having an individual mandate."

AARP's Rother says health insurers' age discrimination must end. John Rother, executive vice president of policy and strategy for AARP, presents an opposing view in today's USA Today (10/23). Rother writes, "The private insurance industry has been discriminating against older Americans for decades, charging them many times more for the same insurance than 'more desirable' younger people pay. Now that we have the opportunity to require fairer and more affordable insurance options, the industry still wants to be allowed to discriminate on the basis of age." He argues that "this unfair practice would continue to keep affordable coverage out of reach for older Americans who need insurance protections the most." Rother also notes that "AARP has been fighting for years to abolish age rating" and "end private insurance discrimination based on a person's gender or medical history," because "discrimination in any form runs counter to who we are."

House may introduce health reform bill next week.

CQ Today (10/24, Wayne, Epstein, subscription required) reports that "House Democratic leaders, believing they are near consensus on how to construct a new government-run health insurance plan, said Thursday they hope to complete their comprehensive healthcare overhaul next week." CQ quotes House Speaker Nancy Pelosi (D-CA) and Democratic Caucus Vice Chairman Xavier Becerra (CA) saying they hope to have the bill introduced next week.

        House bill said to include geographic Medicare reimbursement fix. CQ HealthBeat (10/23, Norman, subscription required) reports, "More than a dozen House Democrats who have long complained that their regions are shortchanged in Medicare reimbursements lined up Thursday behind a healthcare overhaul bill (HR 3200) after Democratic leaders agreed to a geographic fix." The deal, a two-step provision, "could make a dramatic change in the formula for fee-for-service reimbursements, moving the huge Medicare system toward a more value- and outcome-based approach." It would have "the Institute of Medicine would conduct a one-year study of the current system and make payment recommendations," After which a plan would be submitted to the HHS Secretary and then to Congress. "All action would be completed by the time the 'public' insurance option is made available for consumers."

About three million seniors would be partly shielded from Medicare Advantage cuts.

NPR /Kaiser Health News (10/23, Galewitz) reports that "AARP favors cutting funding to Medicare Advantage to bring its spending into line with the rest of Medicare, and it is still weighing the need for the exceptions in the bill." Nora Super, a lobbyist for AARP, says, "While we support reducing the excess subsidies for Medicare Advantage, we also want to ensure that plans have time to adjust to any changes that may be made to Medicare Advantage in order to minimize any impact on our members." Notably, "nearly three million of the 10.5 million seniors in private Medicare health plans would be at least partly shielded from the planned cuts," because "plans serving seniors in South Florida, New York City, and parts of Louisiana would continue to get funding for services outside traditional Medicare over 10 years."

Costs of reform plans said to be greater than public's willingness to pay.

In a Wall Street Journal (10/23, subscription required) op-ed, David W. Brady, a professor of political science at Stanford University and the deputy director of the Hoover Institution, and Daniel P. Kessler, a professor of business and law at Stanford and a senior fellow at the Hoover Institution, say that while public opinion surveys show majority support for universal health insurance, their research shows that support declines as the cost to the respondent rises. Brady and Kessler note their research shows that the costs of the healthcare reform proposals that Congress is considering exceed what a majority of Americans are willing to pay for reform.

Rep. Shadegg argues health reform not in best interest of average Americans.

The Chicago Tribune (10/23) carries an op-ed by Rep. John Shadegg (R-AZ), who argues that the House healthcare reform bill "ignores" the needs of average Americans. HR 3200 will change "every plan in America," and many Americans "will lose the plan they have and maybe the doctors they like and trust. And, the government is serious about making that happen." The legislation will also cause Americans to "lose the freedom to make [their] own healthcare decisions. Washington politicians are seizing the power to control healthcare for their political gain." He concludes that "politicians are rushing this legislation through" in order to "look good," but to the detriment of citizens.

Drugmakers seen as winning in healthcare reform debate.

Time (10/23, Tumulty, Scherer) reports that pharmaceutical companies "have spent more than any other segment of the medical industry to make sure...they come out winners" if the healthcare system is overhauled. In the first six months of 2009, "drug and biotech companies and their trade associations spent more than $110 million...to influence lawmakers," according to data compiled by the Center for Responsive Politics. And, the "return on that investment has been considerable, both in the House and in the Senate." Time also investigates how the drug industry is pushing for 12 years of market exclusivity for biologics, concluding that how the issue "is resolved -- in favor of protecting the biotech industry or opening up the market to generics -- may say a lot about which interest groups will ultimately reap the windfall of the big-stakes battle in Washington."

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