PIERRE — As Congressional leaders negotiate a final health care reform bill, South Dakota’s political representatives are sticking to their guns in the battle over a “public option.”

The controversial proposal for a government-run health insurance program has long drawn fire from conservatives and praise from liberals. Now, Congressional Democrats hope they have a compromise proposal capable of drawing support from both liberals and moderates in the Senate — a public option a provision allowing individual states to opt out.

Democratic Sen. Tim Johnson, a supporter of the public option, praised the compromise in a statement.

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“I am pleased ... the Senate reform package brought to the floor will include a public option,” Johnson said. “I have long been supportive of the public option as a way to ensure affordable, quality coverage to Americans who currently have limited to no options for obtaining meaningful health insurance.”

The exact details of the opt-out mechanism are still being negotiated. It’s unclear, for example, what would be needed for a state to opt out and whether that would be in the hands of a state’s governor or legislature.

Also uncertain is whether states would be able to opt out from the beginning or only after participating in the public option.

Johnson said he expects the shape of the health care bill to change over the course of negotiations in Congress.

“I remain pragmatic in what will be needed for health reform to pass the Senate, and recognize we will continue to perfect the Senate reform package through the amendment process and further debate,” Johnson said.

Republican Sen. John Thune, an outspoken critic of Democratic health care reform proposals, slammed the opt-out provision as almost meaningless.

“It hasn’t changed my view of it much,” Thune said. “A government plan by any other name is still a government plan.”

Thune also said he has other objections to parts of the Democrats’ health care reform proposals beyond just the public option.

He cited a plan to impose a tax on high-value health care plans, and criticized plans to cut $500 billion from Medicare — cuts Democrats say will come from waste but Republicans argue will come at the expense of doctors and patients.

“Sure, states would choose to opt out if they could opt out of the tax increases and the Medicare cuts,” Thune said. “But more likely they’ll get stuck with the tax increases and the Medicare cuts. They just won’t get any of the benefits. You’re almost forcing states into the program even though you’re telling them how they can opt out.”

In an interview Wednesday with National Public Radio’s news program All Things Considered, Gov. Mike Rounds said it was too early to say if he would recommend South Dakota opt out of the public plan. Rounds echoed Thune’s critique of other aspects of the health care proposal.

“The devil will be in the details,” Rounds said. “We haven’t seen a copy of the bill yet, but as we understand it, all of the states — even if they were to opt out — would still be subject to all of the taxes that it’s going to take to put together the public plan.”

Rounds also worried the public plan would drive up insurance premiums for people with private insurance if it were tied to the lower reimbursement rates provided by the Medicare or Medicaid programs.

“If you base the public plan on any kind of a Medicaid rate, it means that other people that would not be part of the public plan would have a higher insurance premium to pay to pick up the higher costs that insurance companies would be billed by doctors and hospitals,” Rounds said.

Whether a public plan will use Medicare or Medicaid rates or negotiate its rates on the market is still being debated by members of Congress.

Democratic Rep. Stephanie Herseth Sandlin said she’s not opposed to a public option — but will refuse to support a plan using Medicare rates, which she believes are unfair to South Dakota.

“I have consistently stated that I could not support a public option tied to Medicare rates due to the devastating impact this would have on the health care delivery system in South Dakota,” Herseth Sandlin said in a statement.

“Should a public option be included in health care reform, it should operate like a private plan — no taxpayer subsidies — and be subject to a trigger, so it would only come into effect if benchmarks we create aren’t met.”

But Herseth Sandlin said too much attention has been paid to the public option and not enough to other aspects of the bill.

“I feel that far too much energy has been expended on this issue at the expense of other areas of reform on which there is widespread agreement, including ending insurance industry practices of denying coverage for pre-existing conditions and dropping someone who becomes sick,” Herseth Sandlin said.

“Going forward, I’ll evaluate the public option proposal in the bill that comes before the House, and in any final bill, in the context of the many other important provisions for South Dakota.”