Before we dive into those specifics, let's first refresh the parts of the bill that are likely leaning one way or the other. First, employer mandate. Will employers be required to provide insurance coverage plans to all employees? Short answer; no. Long answer; for companies employing more than 50 people that do not provide coverage and as a result employees need government subsidies to get affordable care, they will incur hefty fines - upwards of $750 per employee. Will insurance providers face strict regulations preventing them from denying coverages to those will pre-existing conditions? Yes. Will "cadillac plans" be taxed, therefore providing incentive to companies to shop around for lower cost programs and thus resulting in more market competition? Likely not. All of these issues have, for the most part, been ironed out. And now in the 11th hour, we're finally at the meat of the debate, which is that of a public option.
In previous posts I have provided perspective on how each type of program will affect American's, but now it's time to roll up our sleeves and take a look at the different terms of the public option, as proposed and rejected by groups of constituents. As they say, the devil is in the details. What we're seeing from Senate Majority Leader Harry Reid (with the support of Sen. Baucus and Sen. Dodd) is a proposal for the public option to have an opt-out provision for states that wish to not participate. He is including this in his bill that's up for vote in the Senate, and reaching out to conservative Democrats to be on board until it reaches the floor and is open to debate. This move is a risky one, but one deemed necessary because 60 votes are needed to prevent a GOP filibuster, however once passed and on the floor, it only needs 51 votes to pass. Enter Joe Lieberman. Our favorite Independent Democrat from Connecticut is stepping on his soap box to say that he will not be voting in favor of the public option. However, reports say that Lieberman is in favor of getting the bill on the floor, but once open for debate he will side with Republicans to prevent the bill from passing. Amidst increasing pressure from his caucus to vote for the bill (after nearly being booted from his party for supporting John McCain in the 2008 presidential election), Lieberman claims to "hate to" be the one that stops health reform in it's tracks, but one has to wonder if the insurance industry concentration in his home state Connecticut has something to do with it. Lieberman also made clear that he would not support a trigger of the public option, as proposed by Senator Olympia Snow (R-Maine), as a compromise on the issue.
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While I let the mental image of Joe Lieberman filibustering resonate in your mind, let's discuss what's happening with Nancy Pelosi in the House. Pelosi has proposed that as part of the public option, rates must be negotiated with providers in an effort to contain costs. Her opponents in the House are of a more progressive idea and want to hold the public option to a Medicare + 5% rate. The Medicare +5 won't likely make it into the bill, but what's most interesting about the negotiated rate is that it will cost tax payers an additional $85 billion and it is supported by Blue Dogs and other conservative Democrats whose reputation is being fiscally conservative. Reading between the lines on the Blue Dogs who claim to really be looking out for business interests, we see that the negotiated rate means higher payments for providers (hospitals, doctors, drug companies), and less competition for insurance companies.
As I mentioned a few weeks back, President Obama has been strangely silent about his opinions on the proposed bills and has only released recent statements about the public option that leave a lot of room for discussion. Obama has recently said that he supports the trigger plan for public option as proposed by Olympia Snow, which many believe to be because he is adamant about the bill having bipartisan support. He worries that the proposal for the public plan with the state opt-out clause will put the bill in a position to not gain a single Republican vote, which Obama fears will lead to hesitation and eventually a vote against the final bill from conservative democrats who are weary of it being bipartisan. Obama has warned that Sen. Reid's proposal with the public option is a risky one because if it is up for a filibuster due to not gaining 60 votes and ultimately fails, our opportunity for health reform will be lost. That being said, Obama has said in the past that he acknowledges that the only way to fundamentally reform health care is to provide a public option and create a government run system to create competition in the market. However, now after seeing the resistance from Republicans and making motions to appease insurance companies, Obama is being cautious and supporting the trigger. It should also be noted that the trigger option has long been associated with White House Chief of Staff Rahm Emanuel, who is sure to play a key role in the final bill.
So now, the march goes on and we will continue to watch the events as they unfold. Nancy Pelosi is said to reveal the latest proposal tomorrow morning, which will provide more detail on the plant to negotiate rates. Look forward to more key players stepping up and speaking out on each proposed variation of the public option, as I'm sure Sen. Lieberman won't be the last. In next week's post I'll address the rather large elephant in the room: cost containment, how the current political landscape could affect the success of health reform, and how decades past prove that even the most major reforms at the time have not have long term affects on containing costs and what needs to be different this time around.
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