WASHINGTON - Some House Democrats who favor a government insurance plan, a central element of health care legislation passed in their chamber, acknowledged Sunday that it might have to be sacrificed as negotiators work out a final agreement with the Senate.
Representative James Clyburn of South Carolina, the number three Democrat in the House and one who had appealed to President Obama not to yield on the public plan, set out conditions for yielding himself.
Asked during rounds on the Sunday news shows whether he could vote for a final bill that does not embrace a public plan, Clyburn said: "Yes, sir, I can.''
Clyburn added: "We want a public option to do basically three things: Create more choice for insurers, create more competition for insurance companies, and to contain costs. So if we can come up with a process by which these three things can be done, then I'm all for it. Whether or not we label it a public option or not is of no consequence.''
Clyburn was interviewed on CBS's "Face the Nation'' and CNN's "State of the Union.''
Representative Chris Van Hollen of Maryland said the public option is not dead but added that he recognizes the realities in the Senate, where Democrats had to scrape up every vote from their side even to pass a bill without a government plan to compete in the private insurance marketplace.
"Before the House was to give up the public option, we would want to be persuaded that there are other mechanisms in whatever bill comes out that will keep down premiums,'' Van Hollen said on "Fox News Sunday.'' He appeared to sketch out a bottom line without a government plan necessarily included, saying, "We've got to make sure that the final product is affordable.''
Senator Robert Menendez, Democrat of New Jersey, underscored the divisions Democrats will have to bridge when negotiators from the House and Senate meet next month to reconcile the two bills. He said there will need to be more give on the House side than the Senate, which took weeks to find the 60 votes needed for passage.
"If we are going to have a final law, it will look a lot more like the Senate version than the House version,'' Menendez asserted on the Fox program.
The Senate's Christmas Eve achievement brought the nation closer than it has been for generations to a new order in health insurance, one that would eventually require nearly all Americans to get coverage, help many pay for it, and restrict onerous insurance company practices such as denying coverage to people with preexisting sickness.
But nothing will change for anyone until the House and Senate can settle on common legislation, pass it, and send it to Obama to sign. The high stakes have both parties hoping they can find converts from the other side. Nearly every Republican in Congress opposed the measures.
"If some of the Republicans would come forward with suggestions - offer a vote or two or three or four - to take away the need to have every last one of the 60 Democrats, you'd have a much better bill in accordance with the tradition of the Congress, especially the Senate, on bipartisanship,'' said Senator Arlen Specter, Democrat of Pennsylvania, himself a party switcher.
Besides the government-run health option, another controversial part of the health overhaul bills is a proposal to reduce Medicare Advantage subsidies to seniors. The cuts would help pay for expanded coverage for those without insurance.
Though there are marked differences between House and Senate versions, both bills would cut payments to private Medicare Advantage plans, which on average cost the government 14 percent more than traditional Medicare. Insurers have been warning seniors that Medicare Advantage perks such as hearing aids, dental payments, and even gym memberships could fizzle if Democrats cut the subsidies.
But critics say tens of billions of Medicare dollars funneled through private insurers also pay for extras that never reach beneficiaries: multimillion-dollar salaries, foreign retreats for executives, and massive expenditures on marketing to lure more customers to the privately administered Advantage plans that serve as an alternative to government-provided Medicare.
The AARP, which lends its name to a Medicare Advantage plan, and other senior advocacy groups support the Advantage cuts. Despite the belief that Advantage plans offer broad savings for seniors, a Government Accountability Office report last year found wide differences depending on the plan, including home health service costs that could be up to 84 percent more than traditional Medicare.
A half-million Advantage enrollees were in plans with no copayments for hospital stays. But a roughly equal number were in plans with high hospital copayments and no limits on out-of-pocket inpatient expenses, potentially costing patients thousands more.