There seems to be a lot of optimism all round concerning the prospects of moderate and liberal Democrats reaching a deal on the public option. Or more accurately, in lieu of the public option.
Liberals are apparently prepared to hand public-option-over-my-dead-body moderates a major victory by allowing the weak and watery public option to be euthanized. In exchange, they may not only get to expand Medicare and Medicaid coverage, but also see the public option replaced by a scheme that may offer more real competition to private insurers than the currently extant version of the public option would have. This is where things now stand:
A potential deal took shape Monday that could eliminate the public option from the Senate health reform bill, as Democrats weighed big expansions of both Medicare and Medicaid in a bid to break an impasse over the government insurance plan.
After five days of intensive talks among five moderates and five liberals, the outlines of a compromise aimed at appeasing both ends of the Democratic political spectrum were emerging: a plan designed to expand insurance coverage without creating a new government-run program.
Under the compromise, the public option would be removed from the bill and replaced with a new government-administered national insurance plan similar to the Federal Employee Health Benefits Plan, which serves members of Congress and federal workers.
To sweeten the deal for liberals, people 55 and older would be able to “buy-in” to Medicare and purchase coverage in the popular government program for the elderly. Liberal Democrats such as Sen. Sherrod Brown of Ohio and Sen. John Rockefeller of West Virginia have been pushing the idea for years.
The negotiating group is also looking to expand Medicaid to cover people with incomes 150 percent above the poverty line, up from 133 percent under the Senate bill, and to impose stronger regulations on private insurers.
This is what the public plan’s replacement is looking like, at this point:
The idea is that the Office of Personnel Management would choose non-profit plans that met national standards and offer them on every state exchange (unless states opted out). These plans would be private, but the OPM would act as an aggressive purchaser, ensuring that they met high standards and conducted themselves properly. It’s a private option with a public filter, essentially. But more importantly, it’s a menu of national, non-profit plans, which would be much more interesting from a competitive standpoint than state-based, public plans.
But there’s still a lot of sausage-making left. And a lot of details yet to be ironed out, such as who exactly would qualify to buy into Medicare. It is almost certainly not going to be anyone over 55, as the Politico story above suggests. The age limit might morph into 60. But more importantly, the eligibility may be the same as that for the public plan. In other words, nobody covered by employer health-care.
There’s also the issue of wider support. Just because the five liberals (Chuck Schumer, Tom Harkin, John Rockefeller, Sherrod Brown and Russ Feingold) and five moderates (Ben Nelson, Blanche Lincoln, Mary Landrieu, Mark Pryor and Tom Carper) are able to reach a deal, that doesn’t necessarily mean that the entire Democratic caucus will sign on.
Presumably, these negotiations are being conducted in good faith. That is to say, that — unlike the travesty of negotiations Max “Cock-up” Baucus engaged in for so long, where the Republicans involved in the negotiation had made it clear they had no intention of actually voting for the compromise they negotiated — everyone in the Gang of Ten does plan to vote for the compromise on the Senate floor.
That would bring three of the chief Democratic obstructionists — Nelson, Lincoln and Landrieu — on board. But there’s still a “presumably” attached to that. I also wouldn’t put it past Kent Conrad to refuse to go along. (Especially after being roundly dissed by John Rockefeller.) And then there’s always that political transvestite in thrall to the health insurance industry to reckon with, Joe Lieberman. After all, Lieberman refused to participate in these negotiations, after being invited. That could very well signal a determination to vote against the compromise (no matter what it turns out to be). Olympia Snowe and Susan Collins may still have to be brought on board.
Even if a deal is reached today by the Gang of Ten, as forecast, wild and unrestrained celebrations are probably still a long way off.