Two votes cast in the Senate Finance Committee on September 29 appeared to reduce the chances for the creation of a government-operated “public option” in comprehensive health care reform legislation that is now before Congress. The committee voted down two public option proposals, the first offered by Sen. Jay Rockefeller (D-WV) and the second by Sen. Charles Schumer (D-NY). Proponents argue the setback is temporary.
Supporters of a public option say a government-run health plan will keep costs lower by eliminating substantial administrative and profit-related costs and forcing private plans to similarly reduce costs to stay competitive. Opponents believe that any government program will never be allowed to fail and will inevitably be subsidized to an extent that private insurers would not be able to compete. They believe the public option would eventually lead to a single-payer (wholly government funded) health care system.
The public option in the Rockefeller proposal would have been financially self-sustaining, with regular insurance payments made into the plan by participants. In the first two years, payments to participating health care providers would have been based on rates paid by Medicare, which typically pays about a third less than most private health plans. The proposal was defeated in committee by a vote of 15-8, with 5 committee Democrats (Sens. Baucus, Conrad, Lincoln, Nelson, and Carper) joining all 10 committee Republicans in voting against the proposal.
The Schumer proposal was similar, except that payments to health care providers would be negotiated instead of based on Medicare in the first two years. That proposal was defeated by a vote of 13-10, with two of the five Democrats who opposed the Rockefeller proposal (Sens. Nelson and Carper) switching sides and giving the Schumer proposal their support.
While the two votes in Senate Finance would appear to be a setback for public option proponents, supporters such as Sen. Schumer say they are not giving up. Schumer believes there may be an opportunity to insert the option when it comes before the full Senate. That would seem to depend on the willingness of the Senate leadership to push through health care reform with just 51 votes instead of 60, which would depend on their willingness to ram health care reform through by using budget reconciliation procedures and Democratic support alone. That strategy may prove to be necessary in any event to get a health care reform bill passed out of the Senate, regardless of whether it includes a public option.
Assuming health care reform supporters successfully get a bill out of the Senate, even if it lacks a public option, there may still be an opportunity to insert it if the House includes it in its bill. Speaker Nancy Pelosi has been vocal in her support. The final bill at that point will depend on the outcome of negotiations between the House and Senate leadership.
But House passage of the proposal is not assured. While 50 progressive House Democrats sent a letter to House leaders on September 30 expressing support for a public option, others say that there are not enough supporters overall to assure its passage. According to a report in the newsletter Congress Daily, Speaker Pelosi said the key issue will be how the rates paid to health care providers are set. Stay tuned.