Senate negotiations said to have led to a final health-care reform bill with no public option.
By Adele Stan, AlterNet
Posted on December 9, 2009, Printed on December 9, 2009
http://www.alternet.org/bloggers/www.alternet.org/144462/
The Senate team negotiating the final version of health-care reform has arrived at a deal, Harry Reid, D-Nev., announced last night. The package, Reid said, has been sent to the Congressional Budget Office for cost analysis. Details are still sketchy; even senators not on the negotiating team know the particulars. Here's what we do know.
The bad news? The public option is gone.
The good news? The public option is gone.
Why is the absence of a public option in the Senate bill good news? Because the formula for public options considered by senators were so watered down as to be virtually meaningless. In its place, reports say, the bill will offer two features that could lead to a more progressive form of health-care reform in the long run:
- an opening of Medicare to people between the ages of 55 - 64
- a federal health-insurance exchange based on the system enjoyed by federal employees and the senators themselves
The Medicare expansion would be a buy-in for those younger than 65, and would start immediately. People in the younger cohort would pay a premium. The Medicare expansion would start almost immediately upon passage of the bill, but federal subsidies would not kick in for a couple of years -- meaning in the short run, a Medicare card won't be cheap for the younger boomer set.
However, by experimenting with the expansion of Medicare to include a younger population, we have something of a laboratory for a future single-payer system.
When it comes creating accessibility, the Medicare expansion makes sense. People in the 55 - 64-year-old age group find it very difficult to obtain private coverage as individuals -- especially women. And they're the most likely to be out of work, hence uninsured, in this dismal economy. Folks in this age group are, as a whole, more healthy than the elderly population now served by Medicare, so that should help bring down costs. Yet, because they have more health woes than the younger population, the accessibility of this public plan to them could allow for a healthier pool of insurance subscribers drawn from the rest of the population.
The other big piece of the compromise is the creation of a federal insurance excange based on the Federal Employees Health Benefits Program.
FEHPB is often called a cafeteria plan -- meaning that subscribers are offered an array of private health-insurance options from which they can pick and choose. The up side to a national plan based on FEHPB is that it will presumably create measure of competition between insurers, and would, in theory, break up the near-monopoly status enjoyed by private insurers within their geographical regions.
As long as the federal mandate for every American to purchase insurance holds in the final package, costs should be forced down, as healthier people are added to the insurance pool.
The New York Times reports that, built into the the federal exchange, a trigger for a truly public health insurance plan will kick in if the policies sold within the exchange fail to drive down costs. Call that one for Olympia Snowe, the Republican from Maine, whom Democrats need to keep within the health-care reform fold if they hope to pass a final bill.
While, like most progressives, I would have preferred (in the absence of a single-payer system) to see a robust public option in both the House and Senate bills, the math of the Senate appears to make that goal an impossible one to reach. Absent that, the extension of Medicare, a single-payer, public system, to a new constituency could prove to be a foot in the door for a robust public plan down the road. (Even Sen. Bernie Sanders of Vermont, the independent socialist, concedes as much. He essentially endorsed the reported final deal last night on MSNBC's "Rachel Maddow Show.")
If such a plan were to pass and actually work well for the government and the people, the program could be incrementally extended over time to younger and younger people.
All this jockeying and jiggering stems, in part, from yesterday's other big news out of the Senate: the anti-choice amendment offered by Nebraska Democrat Ben Nelson was yesterday tabled by a vote of 54-45. Nelson's amendment would have, like the Stupak amendment in the House bill, made it virtually impossible for women to purchase health insurance policies through the federal exchange that includes coverage for abortion procedures.
Nelson has hinted that, if anti-choice language such as that in his amendment, fails to appear in the final bill, he might join with Republicans in blocking the health-care reform package from coming to a final vote. Democrats would need 60 votes to break that filibuster, and since their caucus holds only 60 seats in the Senate, the loss of any Democrat to that filibuster will require bringing on board an equal number of Republicans.
And that is how the sausage gets made.
Adele M. Stan is AlterNet's Washington bureau chief.
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