WASHINGTON — In his Wednesday night speech to a joint session of Congress, President Barack Obama said he'd attempt to "keep insurance companies honest" by creating a not-for-profit public alternative to compete with them.

Obama stressed, however, that the public option was only a means to the end of eliminating discriminatory practices by insurers and making health coverage more affordable. "And we should remain open to other ideas that accomplish our ultimate goal," he added.

One alternative under serious consideration, strongly promoted by Sen. Olympia Snowe, R-Maine, would hold the public plan in reserve, triggering it only if affordable insurance isn't made available to most Americans by the time the legislation is fully implemented in 2013. Some political analysts and health care experts say this fallback "trigger" approach might be the best way for Obama and Democratic leaders to navigate the treacherous political waters of health care and get something enacted this year.

"If this trigger mechanism is what stands between getting a health reform plan and not getting one, it would be worth doing under those circumstances," said Paul Van de Water of the Center on Budget and Policy Priorities, a left-leaning Washington think tank. "It would not produce a terrible result, but it would be less than (the public option) advocates want."

Robert Moffit, a health policy expert at the conservative Heritage Foundation, said the trigger is a bad idea that has little to do with reducing the number of uninsured and making coverage more affordable and much to do with government's effort to assert more control over health care financing and delivery.

"The reason why this whole thing is happening is that proponents of the public plan can't win this debate," Moffit said. "They want to set up this mechanism that will . . . automatically get what they can't win today sometime tomorrow."

In recent months, Obama has come under intense pressure from opposing factions within his party to take a firm stand on the public plan. Liberal Democrats say such a government-run insurance plan is essential to guaranteeing affordable insurance to most Americans. Many moderate and conservative Democrats, however, agree with Republicans that a government-run plan could undermine private insurers.

In a specific reference to Snowe's trigger proposal, Obama said that "some have suggested that the public option go into effect only in those markets where insurance companies are not providing affordable policies." Others, he added, have proposed "a co-op or another nonprofit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice."

Proponents have long argued that without the competitive pressure of a public option, private insurers would resist calls to lower premiums and eliminate discriminatory practices such as denying coverage to older Americans or people with pre-existing medical conditions. With most Republicans and many moderate Democrats adamantly opposed to increased government involvement in the insurance market, however, Snowe and others think that a trigger would be a reasonable compromise.

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