The Public Option Compromises: An Interview With Sen. Maria Cantwell
Sen. Maria Cantwell (D-Wash.) sits on the Finance Committee. She voted for Jay Rockefeller's public option, only to see it lose. She voted for Chuck Schumer's public option, only to see it lose. Now she's proposing a compromise of her own, patterned from a successful program in her home state. I spoke to her this afternoon.
Tell me about your compromise proposal.
I think we’ve hit the sweet spot. Everybody says they want to have private providers and we’re saying fine. Let the states negotiate on behalf of a population in your state to drive down your costs. Don’t just give subsidies to insurance companies for expensive insurance. This takes about 75 percent of the uninsured and puts them in the program. If some Republican governor somewhere wants to spend more money, fine. But this is a way to drive down costs.
What’s the exact population states can negotiate on behalf of?
People between 133 and 200 percent of poverty. We think that 75 percent of the uninsured population is under 200 percent of poverty.
Why only go up to 200 percent of poverty? A lot of the concern right now is for people between 200 percent and 400 percent of poverty because they don’t have as much in the way of subsidies.
Because right now, that’s where 75 percent of the uninsured population lives. They need the health insurance. You create models within our system that are efficient. I’d be willing to do more, but that’s a different question.
What about me? I make more than 200 percent of poverty. What if I want to join your plan?
That’s for another day, Ezra. This is a big mountain to climb. We’ve got to get a foothold and this is the foothold.
How will the plan work?
The federal government would give money to the states. States would be able to negotiate at local rates. It’s not Medicaid. People didn’t want it to be Medicaid in Washington, either. But the states can use their bargaining power on behalf of that population. We have found in the state of Washington that we have saved around 35 percent of what those same benefits would cost on the private market.
Would the states run the plans, too? Or are they just negotiating prices?
They would do the price negotiation. They would also have to offer two plans. There are four in our state, and people can choose between them.
What do insurers get for participating?
It’s a population of 100,000 people or 40,000 people of whatever a state puts together that is packaged. And when that many people are packaged up, people want to cover them.
Why have private insurers in here at all? Why not just do it like Medicaid, but call it something else?
Because you want to have competition to drive down the price. You want innovation. You have the ability to get people to agree that it’s worth having a public plan. You could get private insurers to cover this population, but you couldn’t without giving the population leverage in the marketplace. We have 20 years experience doing this in Washington, and we’ve achieved these goals.
So the state would say how much it will pay for an MRI?
The state says I want a plan, and here’s what I want in my plan. I want to get this much coverage to these people. Who will provide it for me? I can deliver 50,000 people as customers, but you need to give me a discount. What’s the discount going to be? If we pass this, it will be the first time we’ve allowed states to attain leverage against the insurance industry by negotiating in bulk.
So the idea is, this population suddenly becomes a bloc.
Can they opt out?
States can opt out.
But can individuals leave if they want?
They don’t have to be part of this. They can’t go get the tax credits outside of it because we want them in a bloc. But they can say no to the plan.
Photo credit: By Alex Wong -- Getty Images
October 1, 2009; 3:05 PM ET
Categories: Health Reform , Interviews
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