In the race for health care reform, the latest policy contendor leading the national debate is health care cooperatives.

The three House committees with jurisdiction over health care reform have passed the bill, which includes a public, government-run health care option. At this point, the U.S. House of Representatives approved a general public health care option, which has has sparked local reactions.

"They're discussing co-ops," said Erin Shields, committee press secretary. "That remains part of the dialogue."

A report referencing Indiana's first congressional district -- consisting of Lake, Porter, Jasper and Newton Counties -- and the impact the current version of the House's America's Affordable Health Choices Act would have indicates about 97,000 people, or 14 percent of the district, are uninsured. If the bill passed, it is estimated that 77,000 of those Hoosiers would get health insurance under the public plan, according to a House Committee on Ways and Means report.

U.S Rep. Pete Visclosky, D-Ind., said the high number of uninsured and the high cost of healthcare are part of a national crisis that needs to be solved.

"Every American deserves access to quality healthcare, every provider deserves to be reasonably reimbursed for their services, and no sector should profit at the expense of the many," he said in an e-mail statement from spokesperson Jacob Ritvo.

Now that the House has settled on a public option plan, the Senate is working on its own version of a health care reform bill that looks at cooperatives.

Sen. Dick Lugar, R-Ind., opposes the public option passed by the House, according to press secretary Mark. E. Hayes. He said in an e-mail statement that Lugar "feels strongly we need to focus on improving the economy before anything else."

Sen. Evan Bayh, D-Ind., could not be reached for comment, but according to his Web site he supports "fiscally responsible health care reform that will not increase the federal deficit or raise taxes in ways that will cost jobs or hurt our national economy."

Meanwhile, the public concerns -- voiced at town hall meetings this past week -- is littered with misinformation, according to a radio address by President Obama Saturday, which further muddies the debate.

Thus, local senators, congressmen, health care providers and insurance companies are hesitiant to comment on a bill not knowing more specifics of a cooperative model.

Success in Seattle

One exisiting, successful nonprofit cooperative getting attention is Group Health Cooperative of Seattle.

According to spokesperson Katie McCarth, Group Health consists of about 600,000 members and about 33,000 of those members are active in voting and committees that run the organization. About 11 patients sit on the board of trustees, and these patients have the power to do everything from change the bylaws to fire the CEO.

Doctors who work for Group Health are salaried employees, McCarthy said, so there are no issues with reimbursement rates that exist now with private insurance companies, Medicare and Medicaid.

McCarthy said her cooperative focuses on preventive care, resulting in a system that has dramatically reduced costs with fewer patients geting to the point where they need emergency care or hospital visits.

Private insurance providers say health care needs to be reformed, but that creating a government-run competitor would create an unfair playing field.

"There are many different things that an insurance company must do, in terms of how much risk they must be prepared to undertake," Aetna spokesperson Scot E. Roskelley said. "Would a public option have that? Where would that money come from?"

Roskelley said if a public option's reimbursement rates to hospitals are low, such as with Medicare and Medicaid, a public option would be an unfair competitor for private insurers.

"Perphaps a lot of people will go into this (public option), and if the reimbursement to the doctors and the hospitals is low, then is this going to raise the cost of those who remain in private insurance?" he said. "Because if the hospitals and the physicians' offices have lower reibmursements from a higher number of people, we're going to have to deal with that net vacuum."

Rob Hillman, president of Anthem Blue Cross Blue Shield of Indiana, said in an e-mail statement more than 165 million Americans rely on coverage from their employers, and strengthening the employer-based system would increase the number of insured Americans. And for those without an employer insurance source, he said the company is willing to work with the government to get more Americans insured.

"We support premium assistance for people who earn too much to be eligible for public programs, but can't afford coverage on their own," Hillman said. "We will work with the federal government to equalize tax treatment for individuals who purchase coverage on their own."

Hillman added that there are programs in place now, without health care reform, that could help as many as 12 million Americans gain access to health care.

"We must fix what is broken without breaking what works in the health care system," Hillman said.

Doctors wait and see

Doctors agree, but with few policy makers having extensive experience in the health care industry, many are waiting to see the actual policy.

"It's difficult to ascertain for sure because the devil is in the details," said Dr. Jonathan Javors, D.O. and chief of the section of orthopaedics at Medical Specialists of Indiana. "The less bureaucratic interference we have between us and our patients, the better we can treat them."

For example, Javors said patients are required to find physicians that accept their insurances.

"We are doctors first, and every doctor should be required to take every plan," he said. "I think that would help access substantially."

Javors added that insurance companies at times interfere with patient treatments, costing both the patient and insurance company more in the long run.

"For smaller employers, if they have one newborn baby that has a problem, they see their costs go up 30, 40, 50 percent," he said. "And if there was a catastrophic federal or state program, they wouldn't see their costs go up."

And where the money will come from to pay for such a public health care option is also a concern to health care providers, said Gene Diamond, regional CEO of the Sisters of St. Francis Health Services Inc.

In one version of the public health option, employers would incurr a tax of about 8 percent if they did not offer health insurance, Diamond said, adding that most employers are paying more than 8 percent just to offer their current insurance options.

"Employers might say, heck, it's not worth it, I might as well drop my coverage and allow my employees to go into the public option," Diamond said.

Right now hospitals are losing money because they are paid less by Medicare than it costs to deliver care to Medicare patients.