Legislation that would overhaul the U.S. health care system began to take shape this week as Senate Majority Leader Harry Reid included a so-called public option in the Senate version of a reform bill.

Leaders in both the Senate and House were having trouble with a handful of wavering lawmakers, especially in the Senate where objections from one member can bring action to a halt.

Reid’s move may also embolden conservative Democrats in the House to likewise support a government-run insurance plan.

A public option would let the government compete with private companies in a bid to drive down costs. Reid’s Senate version of the public option would let individual states opt out of the program.

U.S. Rep. Kathy Dahlkemper, Erie, D-3rd District, has come out in support of a public option. “I think it’s a fiscally sound way to go,” she said.

However, Mrs. Dahlkemper parts with House Speaker Nancy Pelosi on what type of public option to have. Mrs. Pelosi supports a “robust” version, Mrs. Dahlkemper said, which would let the public option use a version of Medicare rates instead of negotiating rates with hospitals.

A negotiated rate could cost consumers more, but Mrs. Dahlkemper said Medicare reimbursements in western Pennsylvania are already far too low. Hospitals and doctors can often take a loss on treating such patients.

Mrs. Pelosi doesn’t appear to have the votes for a robust plan. House Majority Leader Steny Hoyer, D-Md., said that switching the design to allow the Health and Human Services secretary to negotiate payment rates with providers — the approach Reid is taking — gets more support for a public option, which Hoyer said currently commands between 200 and 218 votes in the House. A simple majority in the House is 218.

For U.S. Rep. Jason Altmire, D-4th District, McCandless, who represents Farrell, West Middlesex, Shenango Township and a sliver of Hermitage, the public option is only good if competition happens on a level playing field.

A level field means the government option has to go through every hoop the private insurers do. That would include negotiating rates. Altmire said he thinks private companies will do fine competing on an even playing field.

Both Mrs. Dahlkemper and Altmire said they are waiting on a final version of the bill before they commit to a vote.

For Altmire, the deal breaker would be whether the legislation adds to the federal deficit. He has said he will not support a bill that does not pay for itself. He also wants to see cost-cutting measures in health care and tax breaks for small businesses if they end up with an employer-based mandate to provide coverage.

Meanwhile, Mrs. Dahlkemper — who has a piece of legislation attached to the House bill — seemed to be in tentative support, but wants to read the details before she will vote for any specific bill.

Both Mrs. Dahlkemper and Altmire support mandated insurance coverage. They said the only way to cover everyone affordably will be to bring everyone into insurance pools and spread the risk around.

If insurance is mandated, Altmire said there will need to be subsidies to help pay for insurance for the poor.