Policy-ish

The Public Option Dwindles As Lawmakers Compromise

Congress has come up with a sequel to the 1957 film, "The Incredible Shrinking Man." It's called "The Incredible Shrinking Public Option," a national insurance plan favored by Democratic leaders but diminished in each round of negotiations.

Public option form. i i

Has anybody seen the public option? iStockphoto.com hide caption

itoggle caption iStockphoto.com
Public option form.

Has anybody seen the public option?

iStockphoto.com

Priority No. 1 in then-candidate Barack Obama's 2008 proposal to revamp health care was a public insurance plan that would offer benefits similar to what members of Congress enjoy and would be available to the self-employed, small business workers and the uninsured. The Lewin Group, a subsidiary of insurer UnitedHealth Group, found that the plan could cover as many as 43 million people, including 10 million currently without insurance.

Then, the health care debate got under way in Congress. Republicans universally oppose a public plan, leaving liberal and moderate Democrats to battle it out. A new compromise proposal took form this week, but nothing's set in stone yet. Here's a look at some iterations and compromises the Democrats' proposal has already undergone.

The "robust" option: Originally, House leaders wanted to tie the payments to Medicare rates, a proposal that the Congressional Budget Office said could save $85 billion and offer an affordable plan to the uninsured.

The House compromise: Democrats agreed to create a public option that would have to negotiate payment rates with doctors, hospital, and other providers. The CBO also predicted this version of the public option may be more expensive for consumers than its private counterparts, Bloomberg reported. The plan would cover a mere 6 million people.

The Senate committees: The Health, Education, Labor and Pensions Committee created an Obama-style public plan back in July, but attention quickly shifted to the Finance Committee's public-option-nixing quest for bipartisanship. Their deliberations ended with no public option at all.

The Senate compromise: In merging the two bills, Majority Leader Harry Reid, D-Nev., suggested a version of the national plan that would allow state legislatures to opt-out as a compromise (Senators also floated an "opt-in" plan). Reid's idea earned an even slimmer estimate from the CBO, which said the plan would only cover three to four million uninsured people.

Cooperatives: One compromise idea, originally proposed by Sen. Kent Conrad, D-N.D., would create independent, consumer-owned nonprofits with government start-up money, but that didn't satisfy liberal's desire for a government-run plan. The CBO told lawmakers it wouldn't do much for the uninsured, either: In its analysis, "co-ops had very little effect on the estimates of total enrollment in the exchanges or federal costs."

The "trigger": Sen. Olympia Snowe, R-Maine, proposed setting trip wires for insurers that would create public insurance plans only if the private competition fails to hold costs down.

Office of Personnel Management: The latest compromise proposal would let the government's Office of Personnel Management negotiate with private insurers to set up plans for the uninsured, just as it does for federal employees. Privatizing the public option may upset liberals, so to keep them onboard, the compromise may include expansions of Medicaid and Medicare. There's no word yet from the CBO on what this proposal would cost or how many people it would cover, but CongressDaily reports we could see a score as early as today.

Weaver and Villegas are reporters for Kaiser Health News, a nonprofit news service.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.