Registered Nurse Regina White-Taylor (R) explains flu vaccination forms to Keisha Skipper before giving the H1N1 flu vaccine to Skipper's two-year-old son William Skipper (not pictured) at Rush University Medical Center in Chicago, Illinois October 6, 2009. REUTERS/Frank Polich

Democrats in the U.S. House of Representatives struggled on Friday to agree on which version of a government-run health insurance plan to include in a reform bill, but said one was certain to be in the final legislation.

Backers of a liberal robust version of the public insurance plan, including House Speaker Nancy Pelosi, said a head count showed they were a few votes short of the 218 needed for passage but they were still trying to win support.

Two other versions of a government-run public insurance option are also under consideration in the House, and Pelosi said any of the three would meet the goal of creating more choice in the insurance market. [nN21510241]

At the end of the day, we will have a public option in our legislation to keep the insurance companies honest, Pelosi told reporters, describing the choices among the three as good, better, best.

She dismissed a media report that she was dropping plans to include the robust public option in a House bill being crafted from three pending healthcare measures.

By no means is the count complete or any decisions made, she said.

A healthcare overhaul that reins in costs, regulates insurers and expands coverage is the top domestic priority for President Barack Obama, but it has been slowed by battles over cost, size and the government-run public option.

The public plan, favored by Obama and liberals as a way to create competition in the insurance market, has become a debate flashpoint with critics calling it a government takeover that would hurt private insurance companies.

In the Senate, where only one of two pending healthcare bills includes the public option, Democratic leader Harry Reid has focused on a compromise that would create a national public insurance plan but allow states to choose to opt out.

I don't think there's much problem with that, Pelosi said of the Senate compromise.

Some senators have predicted a government-run plan will not get the 60 votes needed for passage in the chamber, where Democrats control 60 votes but at least a dozen moderate Democrats have doubts about a public option.


But many of the party's fence-sitters have said they will consider possible compromise approaches and are waiting to see the final version before deciding.

I'm open to the public option. It depends on how it's structured, Democratic Senator Mark Pryor said on Thursday.

Pelosi and House liberals favor the so-called robust option that would base reimbursement rates for healthcare providers on rates pegged for Medicare, the health plan for the elderly. 

Pelosi said the robust version would save more money than the other two options, which are based on negotiated reimbursement rates. The negotiated rates are favored by moderates and Democrats from rural areas worried the lower Medicare rates would hurt small hospitals.

There is no philosophical difference between a robust public option and negotiated rates. It's just a difference of money, Pelosi said.

House liberals pushing the robust option said they were still working to win undecided members and were close to 218 votes, a majority in the 435-member House.

We are closer today than we were yesterday, said Representative Lynn Woolsey, a backer of the strongest public option.

Inclusion of a public option in a Senate bill would be a major comeback for the approach, widely labeled dead by pundits and some senators after the Senate Finance Committee rejected it earlier this month.

But some polls show the option making slight gains among the public, and it has stronger support among Democrats in the full Senate than in the more conservative Finance Committee.

Democratic leaders in both chambers have been meeting behind closed doors to merge their pending bills -- two in the Senate and three in the House -- into single measures for debate in each chamber sometime in November.

Eventually, the Senate and House will meet in a conference committee to work out the differences and send a final bill to Obama for his signature.

Pelosi said House Democrats had been expecting a battle with the Senate over the public option when the two chambers met and wanted to enter negotiations with the strongest possible stance.

But that might not matter if the Senate includes a public option in its bill, she said.

This is about the end game now, she said. I have to again discuss with my colleagues, what's the best approach to conference?