The three Democrats in New Hampshire's congressional delegation remain committed to the idea of a government-run health insurance plan, even as the Obama administration has hinted that a so-called "public option" may not be essential to health-care reform.
But none of the three - Reps. Carol Shea-Porter and Paul Hodes and Sen. Jeanne Shaheen - ruled out voting for a reform bill that did not include a public option. They noted that no final bill has emerged, and a public option could still be part of that bill.
"I called the White House today . . . and what I was told is that at this point, the public option seems like the best way to get there," Shea-Porter said. "It seems like the commitment is still there."
Republican Sen. Judd Gregg, who is involved with Senate negotiations on the bill, said he would be happy to see the White House backtrack on the public option.
"The public option would destroy health care in this country," Gregg said. "It would lead to a nationalized system. A system where a government bureaucrat would be between you and your doctor, where innovation is stifled because government controls the health-care system, where you'd live, like in England and Canada, with significant rationing and limitations on the ability to get health care, especially after you reach a certain age."
President Obama has said repeatedly that his health plan would include a nonprofit public health insurance company, which would compete with private insurers. But that provision attracted a backlash of criticism from Republicans. Senate Finance Committee member Kent Conrad, a North Dakota Democrat, told Fox News on Sunday that there were not enough votes in the Senate to support a public option.
Over the weekend, Health and Human Services Secretary Kathleen Sebelius said the public option was "not the essential element" of reform, and Obama told an audience that the public option is just "one sliver" in a health-care reform package.
The White House insists it has not backtracked on its support for a public option, but the remarks have raised talk of whether the goals of a public insurance option could be met in other ways - for example, through a cooperative model.
Gregg, who was part of the group that proposed such an approach, described the cooperative as a "patient-owned insurance system that could compete with private insurance systems." It could be modeled, he said, after utility companies or credit unions, which have been structured as cooperatives.
Ned Helms, director of the Institute for Health Policy at UNH and a former co-chairman of Obama's campaign, said administration officials were simply stressing that the goals of reform are more important than the methods used to get there.
Those goals, Helms said, include changing the "fee for service" model of health care to reward outcomes and quality, lessening the rate at which Medicare costs are increasing and ensuring that people are not denied coverage based on pre-existing conditions or price.
Helms said he prefers a public option, which would be "easier to put in place on a national basis" than a cooperative. But he understands the concerns that a public option would dictate pricing to private insurers. He believes Obama wants a public option but could try to achieve a cooperative model as a compromise.
State of the debate
House committees, including one on which Shea-Porter serves, have approved a plan that would include a government-run insurance option. Several bills are working their way through Senate committees.
Shea-Porter said a public option is the best way to offer choice and competition. "America's always been about choice except in health care," Shea-Porter said. "If you had a pre-existing condition or lost your insurance, you didn't have choice about health care. They just turned you down."
A public option would allow those who have good coverage to keep it while helping the uninsured afford coverage, she said. The House bill would give people the same choices that federal employees have, with minimum standards of coverage.
Shea-Porter said a cooperative approach would not be as successful, citing the model of Blue Cross Blue Shield, which began as a nonprofit cooperative but became a for-profit company.
Hodes remains a "strong supporter" of a public option, according to spokesman Mark Bergman. "He thinks it's a good way to lower the cost for everyone, increase competition and put families back in control of their health insurance," Bergman said.
Shaheen, who signed a resolution several months ago supporting a public option, also continues to support one, spokeswoman Colleen Murray said.
Gregg said he is not convinced the public option is off the table. "It's a step in the right direction that the administration is backing away from the public option, if they really are," Gregg said. "The problem is that House leadership . . . and Democratic leadership in the Senate (are) very committed to a single-payer, public-option approach."
Gregg said he believes a public option would be a precursor to a single-payer model, under which the government would run the health-care system. Gregg has proposed a market-based plan that includes providing incentives for preventive care, offering catastrophic insurance plans, requiring insurers to cover all applicants, offering incentives for healthy living, reducing wasteful lawsuits and focusing on major problems like Alzheimer's and obesity that drive up costs.
All or nothing?
Dr. James Squires, president of the Concord-based Endowment for Health, said he believes the floating of the cooperative model instead of the public option stems from the need to attract Republican support and to appease the commercial insurance industry.
He said he found the public option appealing because it means those with pre-existing conditions or of a certain age could not be denied coverage. "If (the cooperative system) meets those requirements, one would say it seems like a reasonable compromise," Squires said. "If it continues to have some of those obstacles that the public plan was trying to address, I think it might be a step backwards."
Sean Mahoney, Republican National Committeeman from New Hampshire, said ideas such as tort reform, tax credits for small businesses, and encouraging stronger competition among private insurers would do more to reduce costs than spending trillions of dollars on a public option or a cooperative.
Kaley Lentini, outreach and communications coordinator for Granite State Organizing Project, which is leading the New Hampshire Health Care for America Now Coalition, said the public option is vital. "It's one of the largest pieces of the equation, the backbone of health-care reform," Lentini said.
Lentini said cooperatives would not be strong enough to compete with private health insurance plans and lower costs the same way a public plan could.