WASHINGTON -- On the Senate floor, Democrats are debating Republicans on health care. Behind the scenes, they're debating each other.
Those closed-door discussions may be less predictable -- and more consequential -- as majority Democrats struggle to settle controversies within the party that are standing in the way of passage of President Barack Obama's sweeping health care overhaul. The most contentious of these is a proposal for the government to sell insurance in competition with private companies, an approach supported by liberals but opposed by most Democratic moderates and conservatives.
Democrats were engaged in urgent talks to settle the government insurance plan issue.
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"Our caucus is now in the process of negotiating with ourselves because we need all 60 of us to get this done," moderate Sen. Mary Landrieu, D-La., said after emerging from one meeting. Senate procedures require 60 votes to overcome Republican delaying tactics designed to kill the bill.
Senate Majority Leader Harry Reid, D-Nev., controls precisely 60 votes, including two independents, but Landrieu and several other centrists are uneasy about the government insurance option in the bill, even though it would be open to a relatively small number of people -- mostly the uninsured and small businesses -- and Reid included a provision that would allow states to opt out of it.
Sen. Tom Carper, D-Del., along with Sens. Mark Begich of Alaska and Mark Warner of Va., are taking the lead in crafting a compromise. The idea remains a work in progress, but the three presented the outlines Thursday evening in a private meeting with about a half-dozen other moderates.
As described by Carper and Begich to reporters, the compromise would put a nonprofit insurance option in place only in states that didn't meet certain criteria for affordability and access. Instead of being controlled by the government, the plan could be run by a nonprofit board, and any initial government startup money would be repaid.
Among those in the meeting was Sen. Joe Lieberman, a Connecticut independent, who has said he would filibuster the bill if a government option was included. He left the meeting early and said his position hadn't altered.
"Generally speaking, I didn't hear anything that changes my mind," Lieberman said.
Others were more optimistic.
"I've still got some concerns, but I am certainly pleased and proud that people are willing to work on it," said Sen. Blanche Lincoln, D-Ark., who faces a difficult re-election next year.
"I think that what's being attempted here is perhaps an alternative to a public option," said Sen. Ben Nelson, D-Neb. "If that were to be developed, then perhaps Senator Lieberman's objections would be satisfied."
After their meeting, some of the centrists met with Sen. Chuck Schumer, D-N.Y., and other liberals who support a government option.
Democrats also face a clash over abortion as Nelson plans to offer an amendment with strict abortion restrictions that liberals say they can't accept.
Nelson's amendment probably will fail when it comes up early next week, but he has vowed to oppose the overall bill if his abortion language isn't included. If Nelson follows through on that threat, Democrats would need all their other 59 caucus members plus one Republican to secure final passage _ making the need for a broadly acceptable compromise on the government insurance plan even more urgent.
Overall, the $1 trillion, 10-year legislation would require most Americans to purchase insurance and provide federal subsidies to lower and middle-income individuals and families to defray the cost. Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be barred.
Freshman Democrats including Warner, Begich and Sen. Mark Udall, D-Colo., were making plans to leave their stamp on the bill with a package of amendments designed to enact tougher cost controls on the medical system. The measures would require Medicare to enact more pay-for-performance instead of pay-for-service measures and broaden the scope of a new independent Medicare cost-cutting board, among other things, according to an outline obtained by The Associated Press.
In floor action Thursday, the bid by the bill's critics to reverse cuts to Medicare failed 58-42.
Associated Press writers David Espo and Ricardo Alonso-Zaldivar contributed to this report.
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