Monday, August 03, 2009

Health Care: Prospects Better for a Public Option

Prospects for a public option are brightening. (Maybe everyone has been watching what's been going on in the Senate Finance Committee too closely, and ignoring what's been going on elsewhere on Capitol Hill) From Politico:

Senate Finance Committee Chairman Max Baucus (D-Mont.) runs the health care negotiations like the patriarch of a sprawling clan, urging his members to keep their feuds within the family.

But internal clashes about the government insurance option have begun to spill into the open — as Sen. John Rockefeller (D-W.Va.) has gone public with his case against consumer-owned health care cooperatives, which are viewed as a compromise between progressives who want a public competitor to private insurers and Republicans who don’t want a new government plan.

“I will be darned if I support or allow to move forward — to the extent that I can make a noise about it — something which sounds user-friendly,” Rockefeller said in an interview. “What I have to worry about is, are co-ops going to be effective taking on these gigantic insurance companies? And from everything I know from people who represent them, the answer is a flat ‘no.’”

With four of five congressional committees having endorsed health care bills with a public plan, the focus now turns to the Finance Committee, where debate on the issue has been heated and mostly private up until now.

It’s the only committee proposing a private-sector insurance cooperative, rather than a government-run plan, as a mechanism to hold private insurers accountable. But the passage Friday of a House Energy and Commerce Committee bill with a strong public plan puts another squeeze on the odd man out, the Finance Committee.

“They may be right,” said Sen. Kent Conrad (D-N.D.), who proposed the co-op model because he believes the public plan cannot clear the Senate. “I have seen no evidence that changes the vote count in the Senate.”

As Congress attempts to overhaul health care, the public plan debate has been among the most volatile, noisy and expensive.

Early last week, progressives thought their top priority looked dim. President Barack Obama told Time magazine that a co-op could meet his definition of a public plan. Senate Majority Leader Harry Reid (D-Nev.) said his main responsibility was getting legislation that could pick up 60 votes and thwart a filibuster, which the public plan is unlikely to do. And liberal House Democrats revolted over a deal with conservative Democrats to weaken the new government insurance plan.

By Friday, though, public plan advocates were suddenly feeling pretty good. They didn’t get exactly what they wanted in the Energy and Commerce Committee bill — their first preference was a government-run plan tied to Medicare rates rather than negotiated rates — but they had strengthened their hand against the Finance Committee.

“There will be a backstop,” said a Democratic Senate official, who spoke on the condition of anonymity to discuss strategy. “It ensured that whatever happens in the Senate Finance Committee, there will be something of a firewall in the conference. The House will be an equal partner in the conference, and they will be united in presenting a pretty viable, strong public option and one of the two committees marking up in the Senate will have done the same.”

Rep. Eliot Engel (D-N.Y.) called the inclusion of the public plan “a line in the sand.”

“We’re trying to provide health care to 47 million uninsured people,” Engel said. “I believe the way to help them is to have a robust public option with plans tied to Medicare.”

The Finance Committee leans moderate to conservative. There are only a handful of Democrats who might go to the mat for the public option, including Rockefeller, Sens. Chuck Schumer of New York, Debbie Stabenow of Michigan, John Kerry of Massachusetts and Robert Menendez of New Jersey.

It’s too early to tell whether the liberal committee members would vote against a bill with a co-op option. They will look at the whole package for affordability measures and make a judgment, aides said. But since Baucus is negotiating with three Republicans, he could lose a few Democrats and still push a bill through his committee.