Thursday, September 10, 2009

Obama Makes Expansive Case For Public Option, Strong Moral Case For Reform

Obama Makes Expansive Case For Public Option, Strong Moral Case For Reform

Obama Makes Expansive Case For Public Option, Strong Moral Case For Reform

Happy Hour Roundup: Big Speech Tonight!

Department Of Pregnant Moments: Kennedy Family Will Be Pelosi’s Guests At Obama’s Speech

White House Talking Points On Obama’s Speech: Republicans Need To Put Up Or Shut Up

Weiner: “I Don’t See Any Way” I Can Vote For Bill Without Public Option

The Plum Line Greg Sargent's blog

Happy Hour Roundup

* A Pelosi hedge on the public option? Brian Beutler notices that after meeting with the President today, Nancy Pelosi said that the public option is still the best way to go — “for the moment.”

* But a Pelosi spokesman says her position has not changed, and sends over her full quote:

“And that’s why — but he said, if you have a better idea, put it on the table. And so if somebody has a better idea of how to do that, put it on the table. For the moment, however, as far as our House members are concerned, the overwhelming majority of them support a public option.”


* Glenn Thrush says there’s no doubt Pelosi is still gung-ho behind a public plan.

* Is Harry hedging? Harry Reid said today that “something like” the public option will survive the leglislative process.

* Jane Hamsher starts talking primaries for any House liberals who support a public option with a “trigger.”

* Are the right and left even remotely equivalent when it comes to “mainstreaming the fringe”?

* Paul Krugman on why the public option matters in political terms:

Let me add a sort of larger point: aside from the essentially circular political arguments — centrist Democrats insisting that the public option must be dropped to get the votes of centrist Democrats — the argument against the public option boils down to the fact that it’s bad because it is, horrors, a government program. And sooner or later Democrats have to take a stand against Reaganism — against the presumption that if the government does it, it’s bad.

* Speaking of the need for Dems to think big politically, others have already linked this, but it’s a must-read: Former top Obama adviser Steve Hillebrand telling Ben Smith that Obama “needs to be more bold in his leadership.”

* In an interview with ABC News, House progressive leader Raul Grijalva expands on hisearlier comment that supporting a trigger amounts to “surrender.”

* And Eric Kleefeld notes that Mark Foley — he of the House page scandal — is hosting a new radio show called “Inside the Mind of Mark Foley,” a title that’s presumably supposed to make you want to tune in to it.

WASHINGTON (CNN) -- President Obama on Wednesday made a passionate call for Congress to fix the nation's ailing health care system in the same spirit that created Social Security and Medicare in difficult times.

President Obama told a joint session of Congress that the "time for bickering" over health care is over.

In a joint speech to Congress heralded as vital to his push for a health care overhaul, Obama offered his most detailed outline for legislation while challenging Republican opponents to build on issues of agreement rather than play politics to exploit differences.

The speech struck a chord with some Americans: Two out of three Americans, who watched the speech, favor his health care plans, a 14-point gain among speech-watchers, according to a CNN/Opinion Research Corp. national poll. Most viewers were Democrats, according to the poll.

He called for serious proposals from Democrats and Republicans to address chronic health care problems and rising costs, but warned he would not "waste time with those who have made the calculation that it's better politics to kill this plan than improve it."

"California's Real Death Panels" - Data Reveals California's Private Insurers Deny 21 Percent of Claims

Wednesday 09 September 2009

by: Amy Goodman | Democracy Now!

The California Nurses Association/National Nurses Organizing Committee has released new data that shows one in every five requests made for medical claims by insured patients, even when recommended by a physician, are rejected by California's largest private insurers. (Photo: José Goulão Photography)

President Obama begins his final drive for health care reform tonight with a nationally televised prime-time address to a joint session of Congress. His speech comes after an explosive August recess consumed by raucous town halls and talk of government-run "death panels." We take a look at California's "real death panels." That's what the nation's largest nurses group is calling private insurers, as new data reveals they denied one of every five claims over the past seven years. We speak with Charles Idelson of the California Nurses Association/National Nurses Organizing Committee.

Guest: Charles Idelson, Communications Director for the California Nurses Association/National Nurses Organizing Committee.

Amy Goodman: President Obama begins his final drive for healthcare reform tonight with a prime-time, nationally televised address to a joint session of Congress.

Heavy negotiations are underway on Capitol Hill as lawmakers return from August recess. So far, legislation has been approved by three House committees and another in the Senate without any Republican support. Negotiations continue in the Senate Finance Committee, where Chairman Max Baucus of Montana is pressing for a bipartisan deal with his so-called "Gang of Six" senators.

Speculation remains over whether the President will insist on a "public option," a government-backed insurance plan that would compete with the private sector. Obama met with Democratic congressional leaders Nancy Pelosi and Harry Reid at the White House yesterday to discuss strategy on the legislation. Speaking to reporters afterwards, House Majority Leader Pelosi said, for now, a public option is a key component to legislation passing in the House.

Rep. Nancy Pelosi: On the public option, I believe that a public option will be essential to our passing a bill in the House of Representatives, because, as the President has said - and I listened to him very carefully - he believes that the public option is the best way to keep the insurance companies honest and to increase competition in order to lower cost, improve quality, retain choice - if you like what you have, you can keep it - and expand coverage in a fiscally sound way, that it saves money. And that's why - but, he said, if you have a better idea, put it on the table. And so, if somebody has a better idea of how to do that, put it on the table. For the moment, however, as far as our House members are concerned, the overwhelming majority of them support a public option.

Amy Goodman: The insurance industry has spent millions of dollars lobbying against the public option, and it's unclear if a bill that includes it could pass in the Senate. A possible compromise would be a provision that would "trigger" a public option only if private insurers are deemed to have not provided suitable care. Another proposal would leave the public option out altogether and replace it with a system of nonprofit cooperatives.

Many are looking to President Obama's speech tonight for answers. His address comes after an August recess consumed by raucous town halls and talk of government-run "death panels."

Well, the California Nurses Association/National Nurses Organizing Committee has just released new data that reveals more than one of every five requests for medical claims for insured patients, even when recommended by a patient's physician, are rejected by California's largest private insurers. The group says this amounts to very real death panels in practice daily in the nation's biggest state.

The California Nurses Association/National Nurses Organizing Committee represents 86,000 registered nurses in all fifty states. Chuck Idelson is the communications director for the group. He joins me here in San Francisco from the studios of Link TV.

Welcome to Democracy Now!, Chuck.

Charles Idelson: Good morning.

Amy Goodman: Talk about this data that you've just released.

Charles Idelson: Well, this is data that the insurance companies have always wanted to hide, and it's just now become available. It documents that the insurance companies have denied, in California alone, 45 million claims since 2002, and in the first half of this year alone, their rates continue to skyrocket. Some of these rates ranged as high as 40 percent for UnitedHealthcare's PacifiCare. And other large, giant insurers like Blue Cross, Health Net, CIGNA, Kaiser were all in the range of 30 percent. So it shows a clear pattern of very high denials by the very insurance companies that people depend upon to assure that they get care they need when they need it.

Amy Goodman: Wait. I want to go through these figures again of the denial rates, of - let's start with PacifiCare, which is here in California.

Charles Idelson: PacifiCare is a subsidiary of UnitedHealthcare, one of the biggest insurance companies in the United States. Its denial rates are 39 or 40 percent, 39.6 percent.

Amy Goodman: Almost 40 percent.

Charles Idelson: First half of this year, almost 40 percent. And then you have CIGNA, which is one-third of all claims, 33 percent. You have Health Net, 30 percent; Kaiser Permanente, 28 percent; and Blue Cross, 28 percent. So those are four of the biggest insurance companies in California. And it's clear that a substantial percentage of their - of the claims that are submitted to them are rejected.

Amy Goodman: What do you feel needs to be done about this?

Charles Idelson: Well, there's been a lot of discussion about the public option in the healthcare reform debate. Our concern is that the problem is not the public option; it's the private option. The insurance companies aren't in business to provide care; they're in business to make profits for their shareholders. One of the ways in which they make profits, the main way they make profits, is by collecting money from patients and from families and not paying money back in claims. They call it a medical loss ratio, every time they make a payment on a claim. So they're in business to do that. They have warehouses full of bean counters and claims adjusters, whose sole purpose is to find reasons to not make payments.

And there are a variety of reasons they claim why they make these denials, having to do with - whether it's paperwork, a war that goes on between the insurance companies and the doctors and the hospitals. They also say that some of the denials are because patients were seeking treatment for care that was not covered by the plan or that they were not eligible for or that were duplicate or were experimental or investigational. What's been very interesting is that they've come up with a variety of reasons; the only they've left out is "the dog ate my homework." But the issue is serious enough that the Attorney General of California, Jerry Brown, has announced he's going to conduct an investigation into the business practices of these companies and why these denial rates are so high.

But it's extremely important that this data has finally come to light, because it reflects one of the key issues that has not been discussed in the national healthcare debate, which is the denial of care by the insurance companies, which is so fundamental to the basic problem with the collapse of our healthcare system in this country. And one of the great tragedies is that issue has not come up in the national healthcare debate, that those practices by the insurance companies go unchecked, that there's nothing in the national legislation that would change this behavior. And that's why so many organizations like ours have been advocates of a Medicare for All, single-payer healthcare reform that would take these private insurance companies out of the business of denying care and gouging people for payments.

Amy Goodman: I'm looking at a piece in the Los Angeles Times, and it quotes Nicole Kasabian Evans, a spokeswoman for the California Association of Health Plans, responding to the data that you've released, saying, "It appears [that] a good deal of the so-called denials are merely paperwork issues," she said.

Charles Idelson: Right. If you put the best face on their claims - and some of the other insurers also said that people were seeking payments for claims that - for coverage that they did not have or for experimental coverage. We don't exactly know all the reasons that they're citing for the denials, and that's one of the reasons the Attorney General is conducting an investigation. But even if you put the best face on their claims, what it demonstrates is how much waste there is in the insurance industry and administrative overhead here. One-third of every healthcare dollar goes to waste and to claims denials.

Amy Goodman: I'm also joined on the telephone by Hilda Sarkisyan. Two years ago, CIGNA denied her seventeen-year-old daughter Nataline's claim for a liver transplant. Amidst mounting public pressure, CIGNA eventually reversed its position, but by then it was too late and Nataline died. Hilda Sarkisyan joins us now from Los Angeles.

We welcome you to Democracy Now!, Hilda.

Hilda Sarkisyan: Thank you. Good morning.

Amy Goodman: It's good to have you with us. You're dealing with your own health crisis right now, is that right? Your back.

Hilda Sarkisyan: Yes, ma'am. Yes, we are.

Amy Goodman: What's happening?

Hilda Sarkisyan: Well, we miss her. We don't have our beautiful daughter with us anymore. And CIGNA is doing this every day, every day. And that's why I'm out there to help other families to stop them. It's not only CIGNA; it's all the insurance industry, that they are placing profit before patient, and it's not right. And they are enforcing the care of people, not their - you know, they should not enforce the care of the people to their deep pockets. It's all about their pocket, all about the CEO, how much he makes. I miss my daughter. I had a beautiful, perfect daughter. I don't have her anymore. I don't.

Amy Goodman: Hilda, describe what happened to your daughter.

Hilda Sarkisyan: Well, we had insurance. We were covered. We thought we had insurance. So it's like having insurance and not having insurance is the same thing. People who have insurance and don't have it, they get the same care. But having insurance and knowing that you do have it, and you are recommended to a certain hospital, because the insurance company only pays if you go to that hospital, you go to that hospital, which in our case was UCLA. We were transferred there. By the way, that's our fourth hospital within, I would say, three years, because they were jumping us around. And finally, you go there. My son gave her the perfect bone marrow transplant, perfect match. And my daughter needed a liver transplant. And so many requests, so many requests, and they were - the doctors were denied. We were denied, until the California Nurses Association stepped in, helped us out.

We had to get out and go to their headquarters in Glendale, make a scene with our family, the Armenian Youth Federation, our church. Why do we have to do that? I'm a mother who should have been next to my daughter. Only if I knew she was going to die that same day, you think I would have that energy to go out there and do that? I could have been holding my daughter's hand and praying with her. This is not right.

We need a better change in this country, and I'm willing to help the President to do that. And I just want to meet him. That's all I want to do. I want to meet him. I want him to feel how it feels not to have a daughter. He has two girls; he should know.

Amy Goodman: What would you tell him?

Hilda Sarkisyan: We need to do a better change. And there's a lot of things that I want to tell him, a lot of things, one-on-one, face-to-face, because if we don't stop this now, every family is going to have my story in their family, in every household.

Amy Goodman: Hilda, we recently spoke to Wendell Potter, a name that may be very familiar to you -

Hilda Sarkisyan: Yes, yes, yes.

Amy Goodman: - the former head of corporate communications for CIGNA.

Hilda Sarkisyan: Yes, mm-hmm.

Amy Goodman: He was the spokesperson for the company when Nataline died.

Hilda Sarkisyan: Mm-hmm.

Amy Goodman: This is some of what Wendell Potter had to say.

Wendell Potter: Even though I was having to represent the company, and again was being as truthful as I could, I all the time was just thinking about the family and the grief that they were going through and the way their - you know, they were briefly optimistic that the decision to cover the procedure might save her life, and then so quickly for that hope to be dashed was just devastating for them, I know, and it was just crushing for me and a lot of people that I worked with at CIGNA, too. I want to make sure that that's understood, that it, you know - I was so disappointed, and I was hopeful, too, that this might be something that actually would save her life. It was just a dreadful, dreadful experience for everyone concerned; there were no winners in that at all.

And certainly, from a public relations point of view, CIGNA really suffered a black eye. And I, as the spokesman for the company - there were two people who really spoke for the company during this time. It was me and the chief medical officer. And I was - my name was on the website, and my contact information was on the website, CIGNA's website, and so people were venting their frustration. I received - I can't tell you how many emails, how many voicemail messages and calls from people who were just outraged. And it was a very difficult - very, very difficult thing to go through.

Amy Goodman: Wendell Potter was the corporate spokesperson for CIGNA when Nataline died, after she had been denied coverage for a liver transplant. Ultimately, in the last hours, the decision came down. It was reversed, but she died at the age of seventeen. Hilda, your response to Wendell Potter, who said it's one of the reasons he ultimately left CIGNA?

Hilda Sarkisyan: Yes, I know. I heard that. And you know what? What happened was, I heard this. It was the day of my daughter's birthday, July 10, and he was out, and that same day we were hosting an annual fashion show when I heard this, and it was just incredible that everything had to happen on her birthday. I mean, there was a reason for all this. And the annual fashion show, I was so strong. I had spokespeople there, and I had - was interviewed. I was much stronger, because I know I'm going to make a change in this country, under my daughter's name.

Amy Goodman: You, yourself, are dealing with a health crisis now, Hilda. You have a back problem?

Hilda Sarkisyan: Yeah, I just had surgery twelve days ago.

Amy Goodman: And how are -

Hilda Sarkisyan: It was an emergency surgery. Let's see how that insurance company is going to react now.

Amy Goodman: And what did they tell you when you came in?

Hilda Sarkisyan: Oh, I just went to the emergency room. The ambulance came and took me. And when they came to have me sign off on a thing on the insurance, and I just told them, "Make sure they don't mess with you." I said, "Just make sure you tell them who is the emergency room right now." And I had surgery right away. I didn't even know I was going to have surgery. So, yeah, I don't have a bill yet. We'll see how that's going to work.

Amy Goodman: Chuck Idelson, your response?

Charles Idelson: Well, it's interesting that Blue Cross, a different insurer, says that what they call experimental cases are one of the reasons for denials. So that's an example of what Hilda is talking about here.

One of the great tragedies here, of course, is that CIGNA reversed itself in the case of Nataline, but they only reversed themselves after massive national public protest. If they were able to reverse themselves at the end of this process, why couldn't they have approved the liver transplant in the beginning? And that's part - that's part of the problem with our insurance-based healthcare system, is it shouldn't take public protest to force the insurance company to do the right thing, to do what they should have done in the first place. Yet that's the reality of what so many families deal with on a daily basis in this country, is insurance companies that deny care.

Amy Goodman: Chuck Idelson, you're going to the offices of Dianne Feinstein and her home?

Charles Idelson: We are. We're doing that today. That has to do with trying to make sure that working people have more of a voice in this country, when they want to be able, in the case of registered nurses, to advocate for patients with public protection of collective representation. So that has to do with the Employee Free Choice Act and that we're trying to request that Senator Feinstein become a co-sponsor of the Employee Free Choice Act, because that's a critical issue to the future of raising living standards and rights for working people in the United States.

Amy Goodman: And you are the - we're in San Francisco now, the home of Nancy Pelosi. Your evaluation of her, as she meets with President Obama? He, about to address a joint session of Congress, whether the public option is going to happen?

Charles Idelson: Well, the public option is, at best, light reform. That's one of the concerns we have. The problem is, as we say, the private option, not the public option. The public option, if it were given the full strength of a large risk pool, enough people were able to participate in it, the government had the ability to negotiate prices, which they're - seem to be bargaining away, might be one of the ways to keep the insurance companies honest. But you can't really keep the insurance companies honest, because that's not what they're in business to do. They're in business to make money. We're the only industrial country that ties healthcare to private profit.

So, even under best case scenario, the public option would be in great danger from being - from still seeing patients cherry-picked by the private insurers and having the sickest patients in this country dumped on them and be threatened with bankruptcy. So, unless you had enough regulatory protections for a public option, it would be in danger of being outmaneuvered and being bankrupted by the private insurers in the first place.

One of the things that's also happening this month is that the House is scheduled to have a full vote on on the idea of Medicare for all. There's also an amendment within the House bill to provide - that allows states to provide for - remove legal impediments so the states could enact single-payer laws, in addition to - as part of the national healthcare reform. Those are issues that we hope your listeners and viewers will support, urge their legislators to support Medicare for All, because that is the only reform that will actually solve our healthcare crisis once and for all.

Amy Goodman: And that is single payer for all, the government pays for the healthcare?

Charles Idelson: It would be expanding Medicare to cover everyone. Ultimately, that is the - would bring us in line with the rest of the industrial world.

Amy Goodman: Well, Chuck Idelson, I want to thank you very much for being with us, communications director of the California Nurses Association. And also Hilda Sarkisyan, I want to thank you, as well, for joining us from Los Angeles. And again, condolences on your daughter, because I know it hurts you every day. Seventeen-year-old Nataline died after being denied a liver transplant - coverage for a liver transplant by her insurance company CIGNA. The reversal came down; within a few hours, Nataline had died. It was too late.

t r u t h o u t | Is the CIA's Excessive Secrecy Near an End?
Attorney General Eric Holder has appointed a special prosecutor to investigate CIA interrogation abuses. However, some human rights groups worry the investigation will avoid going beyond looking into low-ranking officials. ...
Truthout - All Articles -

Torture, Like Terrorism, Is An Issue That Does Not Admit Easily Of Complexity.

The same people who mocked George W. Bush for his “black and white” thinking on terrorism (“you are either with us or you are with the terrorists”) stand ready to accuse anyone who confesses any uncertainty about the issue—what tactics may be permitted in interrogating terrorist suspects, whether the CIA’s treatment of detainees crossed the line, whether to prosecute those who did—of “defending torture.”

At the same time, any attempt to impose legal limits on the war on terror, to hold to account those who may have broken the law in the prosecution of their duties, invites equally lurid accusations from the other side—of criminalizing policy differences, of demoralizing the CIA, even of aiding the terrorists. So it is a probable testament to the political independence, if not the political judgment, of the U.S. attorney general, Eric Holder, that he was willing to wade into this swamp. His boss may come to wish he hadn’t.

Holder’s decision last week to launch an inquiry, headed by special prosecutor John Durham, into allegations of CIA abuse of detainees under the Bush administration, has already drawn fire from both the left and right. Critics among human rights groups and Democratic activists are upset that the investigation will be confined to cases where interrogators went beyond the guidelines set down by White House lawyers in the Office of Legal Counsel—the infamous “torture memos”—and not to the lawyers themselves, or even their political masters. Meanwhile, critics to Holder’s right—notably the former vice-president, Dick Cheney, but also some Democrats—denounce the investigation as at best superfluous, at worst a partisan witch hunt.

But it’s hard to see what alternative Holder had. It is a fundamental tenet of law that those accused of crimes must be possessed of “the guilty mind”—it must be shown they knew they were breaking the law, or at the very least should have known. You can’t prosecute interrogators for following expert legal advice, and you can’t prosecute lawyers for offering it, however flawed it might have been. You can, however, prosecute where interrogators deliberately ignored or exceeded the guidelines—as a 2004 report by the CIA inspector general, also released last week, suggests—in violation of the statutory ban on inflicting “severe physical or mental pain or suffering.” And you can prosecute where a lawyer knowingly counsels actions that are against the law. But that’s a much harder thing to prove.

Indeed, it is a legitimate criticism of Holder that the cases of alleged detainee abuse most likely to come under scrutiny had earlier been referred to a task force of Justice Department prosecutors, admittedly under the previous administration. In all but one case they declined to prosecute, citing insufficient evidence. But nothing says their judgment cannot be reviewed, and in the fevered political climate surrounding the issue, there is something to be said for a little bipartisan redundancy. No, you don’t want each incoming administration investigating the last, or prosecuting those who acted in good faith on the basis of different beliefs, in this case about how best to defend the country. But neither is it plausible to think that such an emotive debate could just be left to lie, notwithstanding Barack Obama’s professed desire to “look forward, not backward.” If Durham reports, as he likely will, that he sees no grounds for prosecution, that is more likely to put the issue to rest.

That will disappoint those for whom the issue boils down to a simple catechism: torture is against the law. The Bush administration tortured. People who break the law should be punished. It will equally disappoint those enamoured of an even simpler catechism: torture works. Whatever works in the fight against terrorism is justified. Nothing should be allowed to detract from that task. Cheney himself defended the policy last weekend as “absolutely essential.”

Both sides yearn for moral clarity, which is understandable and indeed desirable. But clarity is not achieved by reductionism. It is comforting, on the one hand, to believe that “torture never works”—that, as it is often said, prisoners under torture will say anything to put an end to their suffering. But it bumps up against the uncomfortable fact that in some cases there is evidence that it does work. The Washington Postreported over the weekend that waterboarding—the harshest method used by the CIA, and the one most widely agreed to meet the definition of torture, though it was applied to only three subjects—was responsible for turning Khalid Sheik Mohammed, the mastermind of Sept. 11, into the CIA’s “pre-eminent source” on al-Qaeda. The source? The same 2004 inspector general’s report that prompted Holder’s inquiry.

Indeed, it would seem hard to explain, if torture is so ineffective at extracting information, why it is also so widespread. Possibly prisoners will say anything, including the truth.

On the other hand, even if they are induced to give up true information in some cases, how is it to be known whether they are telling the truth in any given case? (In fact, Mohammed told the Red Cross that much of what he told the CIA was untrue.) Or suppose they are. Is that enough to justify it? Is there not still some weighing required? Does the value of the information obtained outweigh the harm done—to the prisoner, to our own consciences? Could the same information not have been obtained by other, less repugnant ways? And of course, there is the little matter that, whether it works or not, torture is against the law.

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Obama's Health Care Address: A Closer Look At What He Said
USA Today
By H. Darr Beiser, USA TODAY By John Fritze and Mimi Hall, USA TODAY WASHINGTON — The
health care debate in Congress has been plagued for months by ...See all stories on this topic

Health Care Reform, Then and Now - Political Punch
So what's changed since then-President Bill Clinton gave his address to a joint session of Congress pushing for
health care reform? A lot of the health care problems he foretold came true. The country's annual health care costs have ...

Obama Presses Hard To Unite Dems On Healthcare And Slaps Down ...
Huffington Post
healthcare concensus plan is plain and simple. And while the Republicans will not loosen their grips on their "bogus claims," as Obama put it, ...See all stories on this topic

Sept. 10 (Bloomberg) -- President Barack Obama pitched his health-care plan to millions of Americans last night. One listener may matter most: Olympia Snowe, the senior senator from Maine, a Republican.

Snowe, 62, is the Republican most likely to support Obama’s proposed overhaul. After the speech, she said she would have “preferred” that the president reject a government-run plan to compete with private insurers. Still, she said she was heartened that Obama spoke favorably of one of her proposals, a so-called trigger that would activate a public option only if private insurers fail to make coverage affordable.

“I was particularly pleased to hear the president’s proposal will require additional spending cuts if projected savings aren’t realized,” she said in an e-mailed statement.

Snowe had told the Senate Finance Committee’s Democratic chairman, Max Baucus of Montana, that she wanted to wait until the president’s speech before deciding, said Senator Evan Bayh, an Indiana Democrat.

Baucus “indicated that he was cautiously optimistic that he might get Olympia Snowe’s support,” Bayh said in an interview on Fox News yesterday.

Snowe’s backing could give any health-care bill the critical 60th vote needed in the 100-seat Senate to push through legislation. It also could give the measure a patina of bipartisanship, which might make it easier for a few wavering Democrats to back it.

“She is the person who symbolically at least offers the possibility that whatever gets accomplished can be called bipartisan,” said Ross Baker, a Congress expert at Rutgers University in New Brunswick, New Jersey.

‘Gang of Six’

Snowe is one of three Republicans negotiating a plan with three Democratic members of the Senate Finance Committee, known as the “Gang of Six.” One of the three Republicans, Senator Charles Grassley of Iowa, assailed Obama’s speech, saying the president “passed up a big opportunity” to build bipartisan support.

Snowe also is one of the few Republican senators to show a willingness to work with Obama -- she was one of only three members of her party to vote for the president’s stimulus package in February -- and the White House has courted her more than any other on health care.

Public Option

On the substance of the overhaul, Snowe and the Democrats may not be far apart. In his speech, Obama made an argument for the public option -- which has been one the main targets of Republican objections -- while saying it wasn’t essential to a final bill “and shouldn’t be used as a handy excuse for the usual Washington ideological battles.” He also said Snowe’s proposal for a trigger was “constructive” and “worth exploring.”

In an interview on MSNBC yesterday, Snowe said she talked to Obama last week and urged him to “take the public option off the table.”

She has called the current system “totally dysfunctional” but has stressed the importance for the private insurance marketplace to remain involved.

Snowe has said she would be open to a national exchange for health-insurance plans, a proposal the White House and some Democrats also are considering, though Obama said last night it would only be available to those without insurance and small businesses. She has said that such a system should be available to companies with more than 50 employees.

Insurance Subsidies

In the Finance Committee, Snowe is also negotiating ways to provide subsidies to low-income individuals to help purchase insurance, with the debate focusing on individuals who earn up to 300 percent to 400 percent above the poverty line. She is also intent on protecting older people from price discrimination by insurance companies.

In addition, she has shown a willingness to consider a federally operated reinsurance program to alleviate some catastrophic health-care costs.

In May, Snowe spoke out against putting a cap on the tax exclusion of employer-sponsored benefits to pay for the measure. In his speech, Obama endorsed an alternative proposal to “charge insurance companies a fee for their most expensive policies.” Snowe had said in the past she was open to such a plan.

Breaks With Party

Snowe has a history of breaking with her party. Along with her support for Obama’s $787 billion stimulus bill, she backed his $14 billion rescue of the auto industry. She also broke with Republicans in 2007, when she helped pass an expansion of the State Children’s Health Insurance Program.

Unlike many other Republicans in Congress, Snowe occasionally applauded during the president’s speech.

Obama last night offered enticements that could draw Snowe’s support. Along with his willingness to compromise on the public option and to embrace a national insurance exchange, he also said he would be willing to study plans to lower health-care costs by curbing medical malpractice suits, which Snowe and many Republicans support.

“I’ve talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs,” Obama said. He said he is directing Health and Human Services Secretary Kathleen Sebelius to authorize demonstration projects in individual states to test the concept.

To contact the reporter on this story: Heidi Przybyla in Washington at

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