In the hours before President Barack Obama had a nationally televised town hall meeting on health care reform, the Review-Journal contacted the offices of the state's federal contingent to get a snapshot of the lawmakers' thinking as the debate rages on how to fix a system that has left as many as 47 million people uninsured, a situation that often sees the uninsured using emergency rooms for medical care at taxpayer expense.

"For Harry Reid, it's all about affordability and accessibility," said Jon Summers, a spokesman for the Senate Majority Leader. "There's one thing we all have to consider: the hidden tax that we're all paying for people using the emergency room as a family doctor. If a public insurance plan helps with affordability and accessibility, he's for it. All options are on the table right now. "

Neither Rep. Dean Heller, R-Nev., nor Sen. John Ensign, R-Nev., believes in a public health care plan touted by Obama and strongly supported by Rep. Dina Titus, D-Nev.

Obama has argued that a government-run option would increase choice and competition and that people could keep their private insurance if they wanted to, but both of Nevada's Republican federal lawmakers say that putting tax dollars into a public plan would increasingly make private plans unaffordable, causing Americans to have fewer choices in their medical care.

"Senator Ensign believes that the Democratic plan would take us closer to a government-run health care system," said Tory Mazzola, an Ensign spokesman. "(He) believes we need health care reform so he is working with several colleagues to draft an alternative solution. He doesn't want to put a bureaucrat between a patient and doctors."

Mazzola said Ensign's plan will make insurance available to all Americans, but at higher quality and lower cost than the public plan that many experts say would end up costing more than $1 trillion to put into effect over 10 years.

Titus doesn't see the public plan as a negative.

"She supports the notion of a public option that will make insurance companies more competitive by enhancing competition," said Andrew Stoddard, a spokesman for Titus.

Stewart Bybee, a spokesman for Heller, said the congressman believes what Obama is pushing would make the American health care system worse.

In a June 21 op-ed in the Review-Journal, Heller argued that "an estimated 120 million people would lose their current health insurance due to introduction of a public plan." He also said a government sponsored plan would cause rationing of health care.

At this point, Urey said Berkley is keeping her options open. If a public plan can hold down costs, she would be supportive, he said.

"She wants to make sure we know what we're doing," said Urey, who added that Berkley is studying many proposals. "She is for extending coverage to 47 million people, that's for sure."

No one in the Nevada delegation will reveal how they believe health care reform should be paid for. Some lawmakers believe taxing workers for employer-provided medical benefits is needed.

"I think people want reform that reduces cost," said Summers. "There are many proposals that we have to study. As I keep on saying, everything's on the table."

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.