Senate eyes another public option compromise

Senate Democrats are weighing yet another iteration of the public option for their healthcare reform bill, a centrist Democratic senator said Thursday.

The latest iteration would establish a national public option run by a not-for-profit board from which states would elect to opt out under certain circumstances, Sen. Tom Carper (D-Del.) said after a meeting of Democrats on the Finance Committee.

"I think at the end of the day there will be a national plan probably put together not by the federal government but by a nonprofit board with some seed money from the federal government that states would initially participate in because of lack of affordability," said Carper, who originally proposed a national public option that states would affirmatively have to opt into. Carper and Sen. Chuck Schumer (D-N.Y.) have shopped around the notion of an opt-out public option and have generated positive responses from a number of senators.

Though Senate Majority Leader Harry Reid (D-Nev.) has not announced any final decision, and Finance Committee Chairman Max Baucus (D-Mont.) and Carper each indicated that major details are left to be settled, Carper's remarks provide a strong hint that the healthcare reform bill that hits the Senate floor in the coming weeks will include some form of public option. 

Baucus has said all year that a healthcare bill with a public option could never get the 60 votes it needs to pass the Senate, a position that has provided cover to centrist Democrats -- and Republican Sen. Olympia Snowe (Maine) -- who oppose or are skeptical about the public option.

In the midst of the talks to shape the final bill, however, Baucus made clear that the total package means more to him than any of its component parts, including the public option. "I’m for national healthcare reform. That’s far more important to me so whatever it takes to get national healthcare passed, I’m for it," he said. "The most robust bill that gets 60 votes, that’s what I’m for."

Baucus convened the meeting to brief committee Democrats on the progress of his discussions with Reid and Sen. Chris Dodd (D-Conn.) of the Health, Education, Labor and Pensions (HELP) Committee to shape final legislation that merges the two committees' bills. Reid had originally wanted to complete that process by the end of the week, which seems increasingly unlikely. But Baucus said they are inching nearer to a conclusion. "I think the bill itself is getting close," he said.

But Baucus insisted that no decisions had been made about whether to include a public option in the bill, like the HELP Committee did, or leave it out, like the Finance Committee did. "That too has not been decided and it would be premature to say because … it probably would be misleading because it’s in flux," he said.

On the surface, the proposal Carper described would seem to satisfy key requirements of both liberals and centrists in the Democratic party. Liberals are adamant that the public option be available right away and in every state. Under the proposal discussed at the Finance Committee meeting, states would have to option of withdrawing from the public option under two possible scenarios: if they proved that private health insurance is affordable in their states or after a set period of time.

Sen. Jay Rockefeller (D-W.Va.), a prominent backer of the public option, reiterated his view that a national public option is a must and that an opt-out compromise might be workable. "I think it should be national. It ought to be an opt out," he said after the meeting. "It's come to the point where they’re fairly close to making some decisions in their meetings," Rockefeller said of the Reid-Baucus-Dodd meeting.

The latest compromise version of a public option could also appeal to centrist Democrats because the federal government would not administer the program nor would taxpayers be on the hook for cost overruns. "We don’t want the secretary of Health and Human Services running this operation," Carper said.

"We want to distance the federal government from running whatever nonprofit option is offered and we don’t want to have the federal government there as the financial backstop in case it goes bad," he said. Like the public option in the HELP Committee bill, this version would have to abide by the same insurance market rules as private companies and have sustain itself with the premiums it collects.