Senate's Battle Lines: The Public Option
Jason Plautz
Wednesday, November 11, 2009 12:56 PM
In advance of the Senate's health care talks, expected to begin next week, NationalJournal.com will explore the big issues the Senate will debate, their possible solutions and the key votes on each one. Today: the public option.
With bills from the House and two Senate committees each presenting different versions of the public option, the contentious issue has gotten no closer to a solution. The bill from Majority Leader Harry Reid, D-Nev., establishes a public option that states could opt out of by 2014, but various drafts of bills in the Senate included a public option tied to Medicare rates, a "trigger" option and, in the final Finance Committee plan, none at all.
Where does the Senate go from here? Here are the major alternatives and the key swing senators who might be on board with them:
Opt-out/opt-in
The opt-out provision currently in Reid's bill would give states until 2014 to choose whether or not to engage in the plan. While some have criticized the plan as a false choice because most state legislators would have a tough time voting choosing to abstain from the plan, others say it is the fairest way to get a public option implemented. Reid says he has strong support for the plan, which has drawn praise from Charles Schumer, D-N.Y., and Jay Rockefeller, D-W.Va. An alternate proposal introduced by Tom Carper, D-Del., would start with no public option and have states opt in.
Set up a trigger option
Olympia Snowe, R-Maine, has said she is "deeply disappointed" in the opt-out plan and would prefer an option that only goes into effect when states fall below a certain benchmark. Democrats would love to court Snowe, the only Republican to vote for a bill in committee and a crucial swing vote who could counteract the loss of a moderate Democrat who does not support a public option.
Carper is working on an alternate version of the trigger option that would set up a nonprofit board in states where insurance does not become more affordable. Carper says the plan could be a good middle ground for moderates unsure about a government-run option. While he hasn't lined up support for the plan, Carper notes that the plan is similar to Snowe's and incorporates the nonprofit idea from Kent Conrad, D-N.D.
Establish a "robust" public option
Many liberals, including Schumer and Rockefeller, have said they would prefer to see a bill with a strong public option, one that reaches across the country and offers low-cost coverage like the one in the House plan. Some would even like to see it go further and tie its rates to Medicare. While Rockefeller and Schumer would probably be conciliatory to the opt-out plan, other liberals like Roland Burris, D-Ill., and Bernie Sanders, I-Vt., have indicated they will not support a plan without a stronger option.
Create a private public option
A proposal from Mary Landrieu, D-La., has been gaining steam. It would use federal seed money to fund an insurance plan that would eventually be run and operated by a private board. Landrieu told Fox News that the plan wouldn't be government-run or federally funded, saying "it's a private insurance model." Landrieu says she has been discussing the plan with fellow moderates and could see it getting the support of five or six, including Snowe, George Voinovich, R-Ohio, and Bob Corker, R-Tenn.
Remove the public option altogether
While this would go against the wishes of President Obama and many liberal senators, eliminating the public option would make the bill more popular with Republicans. Independent Joe Lieberman of Connecticut, who caucuses with Democrats, has threatened to work with Republicans to filibuster the bill if it includes a public option. Moderates Susan Collins, R-Maine and Blanche Lincoln, D-Ark., have also indicated they won't support a bill with a public option.
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