The Blue State Public Option
Sam Stein has a pretty major development:
Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program.
The proposal is envisioned as a means of getting the necessary support from progressive members of the Democratic Caucus -- who have insisted that a government-run insurance option remain in the bill -- and conservative Democrats who are worried about what a public plan would mean for insurers in their states.
"What folks are looking for is what gets 60 votes," said a senior Democratic Hill aide. "The opt-out idea is very appealing to people. It has come up in conversations. I know personally that a handful of members have discussed it amongst themselves."
In conversations with the Huffington Post, sources have said that while the opt-out approach to the public plan is in its nascent stages it has been discussed with leadership in the Senate. It was pulled out of an alternative idea, put forth by Sen. Tom Carper (D-Del.) and, prior to him, former Senate Majority Leader Tom Daschle, to give states the power to determine whether they want to implement a public insurance option.
But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one.
Essentially you'll end up with a blue-state public option, with the possibility of a few referenda to remove it in the states that allow ballot initiatives. Although, as we saw on the stimulus, threatening to opt out of a federal program is far easier than actually doing it. I'd guess that most states would go ahead with it.
As compromises go, this is about as good as anything that's been discussed, certainly better than triggers, co-ops or Tom Carper's "opt-in" proposal. It needs to be a good public option, one with Medicare's provider network and hopefully some relationship to Medicare rates, but if that's the case then it probably even beats Schumer's weak natonal proposal.
The entire exercise is to get to the conference committee with some kind of public option in both houses. That way, getting something out of conference is virtually assured. If you have no public option in the Senate bill, you're not going to get one in the final bill. That's just an educated guess. So Democrats are trying to figure out something that can get through a Senate vote. It's a difficult lift.
Outside pressure remains a factor here. But we're now talking about which kind of public option to have, not whether or not to have one at all. That's a better place to be.