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Will the GOP Oppose States’ Rights on the Public Option? « The Washington Independent

Jul 31, 2020
Now things are getting interesting.
After months of wrestling over how to approach the popular but politically thorny public option, Senate Majority Leader Harry Reid (D-Nev.) is leaning toward including such a provision in the bill he’s weaving together from elements of the Finance and HELP Committee bills, The New York Times reportedlast night.
Mr. Reid’s intentions, which are subject to change, reflect a calculated gamble that all members of his party would vote for the public insurance plan if it included some mechanism for states to opt out. [...]
“There is a growing sense that we need to lead on this issue and not wait for it to be offered on the Senate floor,” a senior Democratic aide said. “The idea is that it’s better to show some fight.’’
For public option supporters, there’s a clear advantageto bringing the public option to the floor rather than trying to attach it as an amendment once it gets there. Namely, that strategy would shift the burden of rallying 60 votes from those wishing to attach the public option to those hoping to remove it — no minor distinction in a chamber featuring 60 Democrats and 40 Republicans.
The opt-out strategy also has obvious advantages. Republicans have been united in their strict opposition to the public option in almost any form. But they also pride themselves on being strong states-rights advocates, and they would have a difficult time explaining to voters at home why it’s a bad idea to allow each state to decide whether the public option is right for its residents — particularly since one in six of those residents currently lacks health insurance, in large part because they can’t afford it.
So why have Democrats been so reluctant to include the opt-out provision? Two words: Olympia Snowe.
The White House wants a bipartisan bill, and Sen. Snowe (R-Maine) has already signaled her disapprovalof the opt-out plan. Snowe instead has been a long-time advocate of a trigger strategy, which would allow for the creation of public insurance plans in regions where private companies don’t meet specific cost and coverage targets by a certain deadline down the road. The Obama administration is reportedlyleaning toward the trigger in order to get Snowe on board.
In certain respects, the trigger is attractive. If the goal is really to make coverage more affordable, the threat to private companies of having to compete with a public plan might just be enough to dissuade them from hiking premiums unnecessarily. But this depends on where those affordability thresholds are set, and whether they’ll remain in perpetuity, pegged to a reasonable cost-of-living index.
The real trouble with the trigger is that it would be limited in scale. In some regions, insurers might meet the cost and coverage targets, thereby precluding the creation of a public plan; in others a public plan might pop up. But this is a far cry from creating the patient pools of the size necessary to compete with the giant insurers on cost. Indeed, liberals have blasted the trigger as a euphemism for no public plan at all.
There’s yet another fallback plan here — one that hasn’t gotten nearly the attention it probably deserves. During the Finance Committee markup of that panel’s health reform bill, Sen. Maria Cantwell (D-Wash.) offered an amendment allowing states to create their own public plans to compete with private insurers. That opt-inapproach passed the committee by a vote of 12 to 11, with Sen. Blanche Lincoln (D-Ark.) the only member to cross party lines. Only residents earning between 133 and 200 percent of poverty would be eligible for the Cantwell plan, but roughly 75 percent of the nation’s uninsured population is estimated to fall within that range.
That’s not everyone. But it’s a good start.
Dexter Cooke

Dexter Cooke

Dexter Cooke is an economist, marketing strategist, and orthopedic surgeon with over 20 years of experience crafting compelling narratives that resonate worldwide. He holds a Journalism degree from Columbia University, an Economics background from Yale University, and a medical degree with a postdoctoral fellowship in orthopedic medicine from the Medical University of South Carolina. Dexter’s insights into media, economics, and marketing shine through his prolific contributions to respected publications and advisory roles for influential organizations. As an orthopedic surgeon specializing in minimally invasive knee replacement surgery and laparoscopic procedures, Dexter prioritizes patient care above all. Outside his professional pursuits, Dexter enjoys collecting vintage watches, studying ancient civilizations, learning about astronomy, and participating in charity runs.
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