Health Care Reform Bill 12 items | updated Dec 10 2009

House Speaker Nancy Pelosi signaled her willingness Thursday to consider a health care bill without a government-run public health insurance option.

Pelosi previously has insisted the public option was necessary for House approval of a health care bill. Last month, the House passed its version of the sweeping health care measure that includes the public option.

However, Senate Democrats agreed this week on a tentative deal to drop the public option from their health care bill to ensure the measure can pass the chamber.

Under a proposed alternative, the Senate bill would permit private insurers to offer nonprofit coverage overseen by the government and expand Medicare for senior citizens to allow people as young as 55 to buy in to the program.

At her weekly news conference, Pelosi, D-California, said she wants to get the Congressional Budget Office analysis of the Senate alternative before judging it, but she opened the door to a final bill without the public option.

"We in the House believe that the public option is the best way to keep insurance companies honest and also to increase competition," Pelosi said, adding: "If you have a better way, put it on the table."

With President Obama supporting the Senate alternative, Pelosi's openness to consider it represents a potential major step toward passage of a health care bill.

Liberal Democrats call the public option the only way to overhaul the health care system by ensuring people have access to affordable coverage and providing low-cost competition to private insurers.

Republicans and some Democrats consider the public option an unnecessary federal intrusion in health care that could lead to a government takeover of the system.

The House narrowly passed its health care bill last month, and the Senate is in the second week of debate. Democrats need all 60 votes in their caucus to overcome a Republican filibuster to pass the bill, and some senators in the Democratic caucus have rejected the public option.

Democratic sources said the Senate deal reached Tuesday night includes proposals to replace the public option by creating a not-for-profit private insurance option overseen by the Office of Personnel Management, much like the health plan for federal workers, along with the Medicare expansion.

A Democratic source with knowledge of the deal said the alternative also includes a "trigger" mechanism that would create a public option in the future if the nonprofit private alternatives fail to expand coverage effectively and bring down costs. However, the source said the trigger provision was tentative, based on whether moderates opposed to a public option would accept it.

Pelosi said he had yet to see details of the Senate plan. She listed essential elements for passing a health care bill, including making coverage more affordable for middle-class Americans, sustaining Medicare's solvency while eliminating a gap in prescription drug coverage for senior citizens, not increasing the deficit and holding insurance companies accountable.

"What I have said, as I've always said to my members, give the Senate room," Pelosi said, adding: "We will know a great deal more when the paper comes back from the Congressional Budget Office. But seeing their bill and our bill, I know one thing for sure -- we'll have a great bill when we put them together."

In particular, the idea of expanding Medicare to those 55 and older was appealing, Pelosi told reporters after the briefing.

Obama said Wednesday the Senate agreement created "a new framework that I believe will help pave the way for final passage" of what he called historic health care legislation.

"I support this effort, especially since it's aimed at increasing choice and competition and lowering cost,"