Senate Negotiators Appear To Resolve Debate on Public Option
On Tuesday, Senate Majority Leader Harry Reid (D-Nev.) announced that a cohort of 10 Democratic senators reached a "broad agreement" on a proposal that essentially would remove the public option from the chamber's health reform bill (HR 3590), the Wall Street Journal reports. Reid said the proposal has been sent to the Congressional Budget Office for scoring (Hitt/Adamy, Wall Street Journal, 12/9).
According to the Washington Post, if the deal over the public option reached by the group of five liberal and five moderate Democratic senators holds up, "it will represent a major breakthrough on one of the most contentious issues of the health care debate." It also could help Senate Democratic leaders garner the necessary 60 votes to avoid a Republican filibuster of the reform bill.
Details of the Proposal
Under the new proposal, people ages 55 to 64 would be able to buy in to Medicare, and private insurers would be required to spend 90% of premiums on clinical services and programs that aim to improve quality of care.
In addition, the Office of Personnel Management -- which currently oversees health policies for federal employees -- would manage a new system of national health plans (Murray/Montgomery, Washington Post, 12/9).
According to Senate aides, in the unlikely occurrence that no private insurers sign up with OPM to offer a national plan, the agency could create a public health insurance plan (Wall Street Journal, 12/9).
Politico reports that the buy-in period could begin as early as 2011, three years ahead of when most elements of reform legislation would take effect. Coverage for the interim period would not be subsidized, according to Politico (Budoff Brown/O'Connor, Politico, 12/8).
Reid said the tentative agreement indicates that the chamber has "overcome a real problem that we had" (Young, The Hill, 12/8). He said that under the new plan, insurance companies "will certainly have more competition. The American people will certainly have more choices" (Pear/Herszenhorn, New York Times, 12/9).
Reid said that it is "not true" that the public option was removed entirely from the bill but declined to provide details on the new proposal before CBO had a chance to score it.
Reid said that CBO Director Douglas Elmendorf told him that if he disclosed parts of the agreement, CBO would have to make the score public without giving Reid a chance to change any elements of the proposal (Pierce/Drucker, Roll Call, 12/8).
Some Resistance Remains
According to the Post, while the negotiators on Tuesday agreed to send the new plan to CBO for scoring, they did not reach an agreement over all elements of the plan.
Sen. Russ Feingold (D-Wis.), one of the liberal members of the negotiating group, issued a statement saying, "While I appreciate the willingness of all parties to engage in good-faith discussions, I do not support proposals that would replace the public option in the bill with a purely private approach" (Washington Post, 12/9).
Reid said, "Not everyone will agree to every piece we sent over there," adding, "[W]e've got something that's good. â¦ It moves this bill way down the road" (Politico, 12/8).
Reid said that no additional steps will be taken until CBO comes back with a cost estimate.
Sen. Tom Carper (D-Del.), one of the key negotiators in the group, said, "Hopefully we'll know something from them by the end of the week" (The Hill, 12/8).
Medicaid Expansion Dropped
In exchange for dropping a public health insurance plan from the bill, liberal senators asked that Medicaid be expanded to cover those making up to 150% of the federal poverty level -- up from 133% in the current bill. However, that provision was dropped on Tuesday (Wayne, CQ Today, 12/8).
According to sources close to the negotiations, the proposal was replaced with an extension of funding for the Children's Health Insurance Program through 2015 (Wall Street Journal, 12/9).
Moderates on Tuesday said that the Medicaid expansion was never seriously considered (CQ Today, 12/8).
Lawmakers, Providers Concerned With Medicare Expansion
The proposal to let people ages 55 to 64 buy in to Medicare has prompted concern from lawmakers representing rural areas, as well as health care providers.
The American Medical Association said that it opposes a Medicare expansion because of low reimbursement rates and the difficulty Medicare beneficiaries have in finding physicians (Wall Street Journal, 12/9).
Sen. Chuck Grassley (R-Iowa) said, "We have a hard time keeping doctors in our state" and "a hard time keeping our rural hospitals open." He added, "If they load more people into Medicare, â¦ the doctors are only going to be paid 80% of costs, hospitals a little less than that" and "we're going to have more problems" (CQ Today, 12/8).
Sen. Kent Conrad (D-N.D.) suggested that some of these concerns could be addressed by putting Medicare buy-in enrollees in a separate group from traditional Medicare beneficiaries, where rates could be negotiated at higher levels (CongressDaily, 12/9).
Centrists who oppose a public option appeared pleased with some of the provisions included in the new plan.
Sen. Mary Landrieu (D-La.) said that she was open to the Medicare expansion. "Medicare is a public program that works, for the most part, as long as we strengthen it and we reform the delivery system," she said (CQ Today, 12/8).
Sen. Joseph Lieberman (I-Conn.), who has been a vocal opponent of a public plan, called the OPM proposal an "an interesting idea" (Wall Street Journal, 12/9). Of the proposal to expand Medicare to people ages 55 and older, Lieberman said, "They're not asking for a compromise on the public option now; they're asking for a trade-off. â¦ I appreciate that a lot, and I'm open to those kind of discussions."Snowe expressed some skepticism over the Medicare buy-in proposal, saying that the potential costs were too high at about $7,600 annually per person (CQ Today, 12/8). Snowe said that she would be willing to consider a Medicare expansion if states with particularly low Medicare reimbursement rates were better compensated and if there was an assurance that traditional Medicare would not suffer because of the expansion (Washington Post, 12/9). 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.