Moderate Democrats Warm Up to Proposal for Public Plans for States
A proposal to give state officials the option of creating a state-based public insurance plan is gaining traction among some influential centrist Democrats in the Senate, the Wall Street Journal reports.
Senate Finance Committee member Tom Carper (D-Del.) recently circulated the proposal as an alternative to a government-run public option and a network of not-for-profit health insurance cooperatives.
The Finance Committee last week rejected two attempts to include a national public option in its health reform bill.
Under Carper's proposal, states would be able to act independently or in partnership with other states to set up public plans. The public plans would be held to the same rules established for private companies using the national insurance exchange laid out in the Finance committee bill. States also could opt to offer their state workers' employee-benefit plans to the other residents.
Sens. Kent Conrad (D-N.D.) and Ben Nelson (D-Neb.) -- both moderate Democrats and members of the Finance Committee -- expressed support for Carper's plan.
Sen. Olympia Snowe (R-Maine) -- who has pushed for the adoption of a so-called "trigger" to create a public option if private insurers fail to provide affordable coverage to residents -- cast doubt on Carper's plan (Hitt/Adamy, Wall Street Journal, 10/7).
Baucus Faces Criticism From Home-State Officials
In a related development, Senate Finance Committee Chair Max Baucus (D-Mont.) is facing criticism about states' share of funding for a proposed Medicaid expansion, Roll Call reports (Drucker, Roll Call, 10/7).
Current health reform legislation would make anyone whose income is lower than $14,404 annually eligible for Medicaid, potentially adding 11 million new beneficiaries. The federal government would pick up between 77% and 95% of the cost of the expansion, with states contributing the difference.
Under a deal reached between Baucus and Senate Majority Leader Harry Reid (D-Nev.), the federal government would contribute 100% of the cost of the expansion in Michigan, Nevada, Oregon and Rhode Island for the first five years (California Healthline, 10/5).
To be eligible for the exemption, states must have had an unemployment rate of at least 12% in August and have a Medicaid program covering less than 12% of their populations.
On Tuesday, Sen. Jon Tester (D-Mont.) said, "We've got to determine how much Montana's going to be on the hook, in the end, if at all. We'll just analyze it," adding, "I don't want to transfer any cost down to the states."
According to Tester, Montana Gov. Brian Schweitzer (D) has made his opposition to the proposal clear.
Schweitzer's office declined to comment on the issue, according to Roll Call. Roll Call notes that Schweitzer -- chair of the Democratic Governors Association -- co-signed an Oct. 1 letter to the Finance Committee expressing broad support for its bill.
Baucus has said that he does not expect the Medicaid expansion proposal to pose problems, adding that Schweitzer has not raised any concerns about the proposal with him (Roll Call, 10/7).
States' Role in Health Reform
The "real action" in health reform "may well be in the states, which could have a surprising degree of autonomy in determining how they implement the federal legislation, and whether it delivers on the promise of curbing soaring costs and providing coverage for nearly 50 million uninsured," Time reports.According to Time, "Much of the reason Baucus molded his bill to give states more control was to allay concerns of moderate Democrats (and Republican Olympia Snowe) that the federal government was inserting itself too deeply into the health care system," but "if the states aren't up to the task, those same politicians could find themselves blamed for health care reform that doesn't deliver, with less tools than they might have had to fix it" (Pickert, Time, 10/7). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.