House Speaker Launches Compromise Health Reform Bill With Public Option

The House of Representatives now has a compromise health reform bill to consider, with Speaker of the House Nancy Pelosi announcing the merger of the House's three versions of health legislation that passed through committees. This means both chambers of Congress are now preparing for debate on final reform packages.

The merged House bill does include a government-operated insurer, as expected, but its reimbursement rates would be negotiated with providers, not tied to Medicare levels. It's similar to the public option favored by the fiscally conservative Democrats -- known as "Blue Dogs" -- that forced an earlier compromise in the House Energy and Commerce Committee's bill.

The Congressional Budget Office reportedly estimated the spending of the legislation to be $894 billion over the next decade -- just under the $900 billion threshold set by the Obama administration. The CBO also indicated that this bill would be deficit neutral over that period, according to Pelosi.

"The drive for health care reform is moving forward," Pelosi said at an Oct. 29 public event on the steps of the U.S. Capitol, surrounded by a crowd of Democratic lawmakers. She called it a "historic moment," and said this bill provides "affordability for the middle class" and "security for our seniors." Pelosi said the proposal "insures 36 million more Americans."

Still, no Republicans have said they would support the idea. And though the Senate's version also includes a so-called "public option" insurer, it's unclear that Democratic leaders there will be able to find enough support in their own caucus to bypass a potential Republican filibuster.

Health insurers greeted the news with expected resistance. "A new government-run plan would bankrupt hospitals, dismantle employer coverage, exacerbate cost-shifting from Medicare and Medicaid, and ultimately increase the federal deficit," according to a statement from Karen Ignagni, president and chief executive officer of America's Health Insurance Plans, which supports some reforms, but opposes a public option of any kind.

A number of moderate Democrats have said they oppose the public option, while some lawmakers on the more liberal end of the Democratic spectrum have said they wouldn't support a bill that doesn't have it. House leaders need 218 votes -- a requirement Pelosi suggested she's confident of reaching this month. The Senate would need 60 votes, though some in the 60-member Democratic caucus are still withholding their support. When Majority Leader Harry Reid announced his own compromise bill days before Pelosi's, he said he believes the margin can be achieved.

If both the House and Senate manage to pass their reform bills, the differing pieces of legislation would have to meet in a combined conference committee, where a compromise would be hashed out that would again have to approved in each chamber. Though both the House and Senate's bill include public options, there are significant differences that could make a final compromise challenging. The Senate's version of the public option would allow states to opt out of the program.

At one point, there was a disruption from protesters of Pelosi's announcement event. She turned to the source of the noise and said, "Thank you insurance companies of America."

The White House issued a statement saying President Barack Obama is pleased that the legislative proposal includes a public option.