A guide to the public option compromises in the Senate
There are three "compromise" public options currently being considered in the U.S. Senate (and yes, I know many argue that the public option is itself a compromise, and there's something to that). Ben Nelson is advocating one. Olympia Snowe is behind another. Jay Rockefeller is talking up a third. Herewith, a guide for the perplexed:
The "trigger" option: Identified with Snowe (interview here), the trigger would call a public option into being in states where there weren't a certain number of affordable insurance options available to a certain percentage of consumers shopping on the exchange. As you might imagine, "certain number," "affordable" and "certain percentage" are contentious terms here. Snowe's original proposal called for the public option to trigger if, after accounting for subsidies, there weren't two or more options available to 95 percent of residents at less than "3 percent of [adjusted gross income] at 133 percent of the Federal Poverty Level, to 13 percent at 300 percent and above."
The state "opt-in" option: First proposed by Sen. Tom Carper (interview here), this proposal would allow states to create their own public options for their own exchanges. California, for instance, could decide it wanted a public option, and Alabama could decide it didn't want one, and both could have their way. The downside to this compromise is that many states are very small, so their public options would be quite weak. The upside is that if a state entered into an agreement with other states, you could have Pennsylvania's public option being sold on, say, Delaware's market. Ben Nelson has been talking this up.
The national "opt-out" option: This is Sen. Chuck Schumer's modification of Carper's proposal, and it's attracted some kind words from Rockefeller. Schumer's vision is to have a national public option that states can opt out of if they choose. In other words, the administration would be national in scale, but Alabama could decide against offering the public option on their state's exchange. The downside to this is that some states won't have access to the public option. The upside is that the national option would have the strength to potentially succeed, and if it did prove able to offer lower costs and higher quality, it's hard to imagine even conservative states denying their residents access to it for very long.
The politics of this are changing by the day, but my sense is that Snowe's trigger has fallen out of favor, and the moderates are now rallying around Carper's compromise while the liberals are putting their shoulder behind Schumer's proposal.
Photo credit: Mark Ralston/Getty Images
October 22, 2009; 11:02 AM ET
Categories: Health Reform
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