Public Plan

Len Nichols, Director of the New America Foundation's Health Policy Program, shares his thoughts with the Washington Post and explains why the Senate's health reform bill is getting better:

The Senate bill is getting better in three ways:

It’s Day 10 of the Senate floor debate on health care reform. Senators can probably look forward to more late nights and plan on working weekends before the debate comes to a close -- but for now, let's take a look at their progress.

As the Senate continues its historic debate of health reform, here’s a look back at the weekend’s action and look forward at what’s to come. As always, you can follow the debate live with us on Twitter (hashtag: #senatedebate)

The public plan has seen more reincarnations than the Dalai Lama.

When Harry Reid released his merged Senate bill, he breathed new life into the debate, by including a public health insurance option that would allow individual states to opt out. Now, Senator Tom Carper (D-DE) hopes to reach that 60 vote threshhold  with a compromise that could assuage moderates'  fears while keeping liberals on board.

The details, which could be unveiled as soon as next week, are still up in the air. Carper’s been working closely with Senators Chuck Schumer (D-NY) and Mary Landrieu (D-LA) as well as a familiar dealmaker from Maine, Senator Olympia Snowe. The Hill’s J. Taylor Rushing and Bob Cusack provide an overview  and lay out in broad strokes what Carper’s plan might look like:

Slate's Timothy Noah provides a thoughtful overview of the intellectual origins and political evolution of the public option's place in health reform.

It's a complicated case, the public option. Lotta ins. Lotta outs. But Timothy Noah is the Big Lebowski of health writers, and is the man for the job to keep all these strands together. (Yes, we know we've made that joke before, but like our living room rug it really ties the blog together.)

Noah's goal was to understand why the CBO and others estimated that premiums for a so-called level playing field public option would cost more than private plans. Noah spoke with New America's Len Nichols, whose paper with John Bertko helped outline how a public option with negotiated payment rates could compete on a level playing field with private plans.

First, thank you to all our veterans for their service and sacrifice.

This Veteran's day we're a bit caught up in the upkeep of grant reports, so he's a quick run down of the news and issues that caught our attention:

This post appears on the National Journal's Health Care Experts Blog where you can also see what other health policy analysts have to say about allowing states to opt out of a public health insurance option.

The public plan debate marches on this week as we discuss whether or not states should be allowed to “opt-out” of the public health insurance plan. Allowing states to choose not to provide the public health insurance plan as an option in their markets has its virtues. It establishes the infrastructure necessary to create a public health insurance plan nationwide, but it also makes the decision ultimately a state judgment. This may be a safer way to go for those who worry about government expansion.

While we do not know the details of what kind of public plan states would be able to “opt-out” of, we suspect the center of gravity is closer to a level playing field approach, such as that proposed by Senator Schumer (where the plan would have to negotiate payment rates with providers) as opposed to the version supported by progressive Democrats in the House (where the plan would administer prices based at least in part on Medicare rates). If the level-playing field approach is in fact adopted, assertions that the plan would simply “underpay providers” rather than “driving real reforms that bring down costs and improve quality” are unfounded.

We were tempted to say that providing all Americans with affordable health care is not as hard as landing on the moon... but then we remembered that we have landed on the moon...

Sen. Joe Lieberman (I-CT) may not be, to use Harry Reid's own words, "the least of Harry Reid's problems."

Senate Majority Leader Harry Reid (D-NV) said the merged health reform Senate bill will contain a public plan option but states can opt out until 2014. He said the "public option" is not a silver bullet but will boost competition, keep insurers honest, and give people more choices. He said it will add "meaningful reform" to a broken health care system.

Friday, the Kaiser Family Foundation released the latest results of the monthly Kaiser Health Tracking Poll. Public opinion is holding fairly steady from last month's poll, starting a gradual rebound after support for reform dipped during the raucous August congressional recess.

A majority of respondents (55 percent) believe it is more important than ever to tackle health reform right now. By party, that's 73 percent of Democrats and 55 percent of Independents, but only 30 percent of Republicans. A majority of Republicans believe they would be worse off if health reform passes, while only 29 percent of Independents and only seven percent of Democrats believe health reform would hurt them. According to the Kaiser Family Foundation's Mollyann Brodie, 8 out of 10 Americans are in favor of eliminating insurance denials based on pre-existing conditions, making it the most popular of all the reform provisions currently under consideration. The poll also found a majority of Americans are confused about the timetable of reform, thinking insurance market reforms and help for the uninsured will occur immediately after the bill is passed -- in reality, changes will be phased in over the course of several years.