Can he support a public option if states could opt out of the plan, as the current bill provides? “The answer is no,” he says in an interview from his Senate office. “I feel very strongly about this.” How about a trigger, a mechanism for including a public option along with a provision saying it won’t be used unless private insurance plans aren’t spreading coverage far and fast enough? No again.

So any version of a public option will compel Mr. Lieberman to vote against bringing a bill to a final vote? “Correct,” he says.

Consequently, we’re left with 41 senators likely to oppose cloture for a bill with a public option, meaning that unless one of these senators changes his or her stance, there’s no way such a bill can win the 60 votes necessary to overcome a filibuster and receive a final up-or-down vote.

Either someone’s going to have to budge, or we’ll see a revised bill that lacks a public option (but might contain a trigger or another mechanism to pressure insurance companies to contain costs) — or Democrats could attempt to pass a public option through the budget reconciliation process, which requires a simple majority.

Keep checking the Senate Public Option Scoreboard for the latest updates.

Sen. Jay Rockefeller (D-W.Va.) (Photo by Mark Murrmann/ZUMA Press)

The Democrats’ proposal to terminate the Children’s Health Insurance Program would hike health care costs for some of the country’s low-income families, likely increasing the number of uninsured kids in the name of expanding coverage, several health policy experts and state health officials warned Friday.

Under the sweeping health reform bill passed by House Democrats last weekend, CHIP would cease to exist at the end of 2013, instead shuffling those kids into Medicaid or private insurance plans on a proposed insurance marketplace, called the exchange.

Image by: Matt Mahurin

Stan Dorn, senior health policy researcher at the Urban Institute, said there are certain advantages to scrapping CHIP. Both Medicaid and exchange plans, for example, would never require congressionalreauthorization — a process CHIP is subjected to every few years, he pointed out. But due to CHIP’s affordability, Dorn said “it’s clear” that kids “are much better off” under CHIP than they would be under private exchange plans.

“It’s not even a close question,” Dorn said during a children’s health care forum on Capitol Hill Friday.

Studies suggest Dorn’s concerns are valid. One analysis, conducted by Watson Wyatt Worldwide, an actuarial research firm, found that families living between 175 and 225 percent of the federal poverty level pay just 2 percent or less of treatment costs under CHIP. Under the proposed exchange plans, researchers found, those same families would pay up to 35 percent of their children’s health costs.

Nate Checketts, director of Utah’s CHIP program, noted that the move to more expensive exchange plans would only discourage low-income families already pinching pennies in the economic downturn. “Unless there’s a mandate, I don’t think those low-income families will sign up for it,” saidChecketts.

CHIP was created in 1997 with broad bipartisan support and renewed for five additional years last February. The popular program is designed to cover children in low-income families that are ineligible for Medicaid. The House bill would both expand Medicaid and dismantle CHIP, sending some kids currently covered under the program into Medicaid plans and others into private plans on the exchange.

The Senate Finance Committee also initially proposed to terminate CHIP when it unveiled its legislation in September. However, the committee last month approved an amendment, sponsored by Sen. Jay Rockefeller (D-W.Va.), to reauthorize the program through 2019.

Supporters of the House proposal argue the advantages of centralizing control over CHIP coverage. Because CHIP is managed by states, there is a fear among some lawmakers that lean economic times could lead to sharp CHIP cuts in some spots, leaving those kids without any coverage at all. Those fears were almost realized earlier this year when California, facing a severe budget squeeze, temporarily froze new CHIP enrollment. Some health policy experts have pointed out that it’s probably not a coincidence that many House Democrats pushing the CHIP repeal are from California, including Speaker NancyPelosi, Rep. George Miller, who chairs the Education and Labor Committee, and Rep. Pete Stark, who heads the Ways and Means health subpanel.

Rep. John Dingell (D-Mich.) has also defended the plan to terminate CHIP, arguing in a recent email that “enrollment of kids increases when the entire family can be enrolled under one plan.”

Checketts agrees, pointing out the difficulties that can arise when family members’ health coverage is scattered across different programs. “It is a good goal,” he said, “to get families on a single source of coverage.”

Yet some analysts have concluded that affordability is the more significant factor to ensuring coverage.

The advantages of providing families with low-cost access to health coverage for their kids, Dorn said, “significantly outweighs the benefits of putting parents and kids in the same health plan.”

Other children’s health care advocates are agnostic. Jocelyn Guyer, co-executive director at Georgetown University’s Center for Children and Families, said Friday that, while CHIP has proven “a great success,” getting affordable coverage for kids is more important than what program provides it.

Ron Pollack, executive director of Families USA, a consumer health care group, also indicated that affordability is more critical for ensuring children have health insurance. “What are the out-of-pocket costs, and what is the care that they’ll receive?” Pollack asked, without endorsing either the House or Senate approach to CHIP.

If an analysis by the Congressional Budget Office is correct, the Senate’s plan to salvage CHIP is the more affordable option. Examining the Senate Finance Committee’s initial proposal to repeal CHIP, CBO Director Douglas Elmendorf noted last month that “some of those children would be eligible for subsidized coverage in the exchanges but would not be enrolled in an exchange plan.”

The reason, Elemndorf explained, is “at least in part to the higher premiums and higher out-of-pocket costs that they would typically face in such a plan.”

There are roughly 46 million people living in America without health insurance coverage, representing about 15 percent of the nation’s population, according to the most recent numbers from the U.S. Census Bureau. But they aren’t distributed evenly around the country.

In Texas, for example, the uninsured rate in 2008 was the highest in the nation at 24.1 percent, while just 4.1 percent of Massachusetts residents lacked health coverage, representing the country’s lowest rate, the Census data revealed.

There’s nothing new or unusual about these distinctions. States have their own laws, and some have simply put greater emphasis on getting health coverage for residents. What’s interesting in the context of the insurance reforms working their way through Congress is how the highest uninsured rates are largely concentrated in the South and the Mountain West, where the lawmakers tend to be more conservative — and more likely to oppose the Democrats’ health reform plans.

This Census Bureau map tells the tale (click to enlarge):

The irony, of course, is that the same people who stand to benefit most from making insurance more affordable and accessible are also most likely to be represented by Republican lawmakers who are fighting tooth and nail to kill the reform proposals.

Hannah Dreier contributed research to this article.

Benjamin was unanimously approved by the Health, Education, Labor and Pensions Committee on Oct. 7, but Senate Republicans are holding up all [Department of Health and Human Services] nominees over a so-called gag order on insurance companies that have been critical of Democratic efforts to reform health care.

“We’ve not received any recent calls from the administration about their nominee,” a senior Republican aide said. “There won’t be any time agreements for confirmation of HHS nominees until their actions have been fully reviewed.”

At issue is an investigation of insurance companies by the Centers for Medicare and Medicaid Services, a division of the HHS, which announced the probe last month after a letter surfaced from Humana to seniors critical of the Senate Finance Committee’s health care bill.

CMS officials charged that the letter contained misleading information, a claim Republicans have disputed.

That’s it. Because of that, HHS is working without a surgeon general during the H1N1 outbreak. Local newspapers in the deep South have noticed, and called for Benjamin to get an up-or-down vote, but this issue really hasn’t gotten anywhere in the beltway.

While Benjamin has waited in limbo, Democrats — who ostensibly run the Senate — have held two hearings on whether the president is appointing too many czars.

As Committee Chairman Patrick Leahy (D-Vt.) explained at the hearing, the health insurance industry — unlike any other private industry in the country — is allowed to engage in price fixing, bid rigging and market allocation, all of which would violate the law if any other sort of company did it. Last month Leahy introduced the Health Insurance Industry Antitrust Enforcement Act of 2009, which would repeal the antitrust exemption for health insurance and medical malpractice insurance providers. Sens. Harry Reid (D-Nev.), Dianne Feinstein (D-Calif.), Russell Feingold (D-Wis.), Charles Schumer (D-N.Y.), Richard Durbin (D-Ill.), Arlen Specter (D-Pa.) and Al Franken (D-Minn.) are co-sponsors.

Although Lawrence Powell, a professor at the University of Arkansas, testified on behalf of the Physician Insurers Association of America in support of continuing the antitrust exemption, even he struggled to explain why it makes sense. He repeatedly said that allowing insurers to share data on losses and costs of claims helps insurance companies price their services accurately and competitively. But as Leahy made clear in his questioning, his legislation would not prohibit such data-sharing. That led Powell to stumble and say that while he’s “not an attorney,” his understanding was that insurance companies would have to file a request to pool data, which would impose additional costs.

But Robert Hunter, Director of Insurance for the Consumer Federation of America and former Federal Insurance Administrator under Presidents Ford and Carter, saw it differently. In his view, the antitrust exemption, intended initially to be temporary but made permanent during closed-door conference committee sessions of Congress more than 50 years ago, must be repealed to overcome the insurance industry’s anticompetitive practices that have led to higher prices and reduced services. “It is high time that insurers played by the same rules of competition as virtually all other commercial enterprises operating in America‘s economy,” he testified.

According to Hunter, health insurance companies have been able to consistently pay less on claims by agreeing to lower the amounts they reimburse doctors and hospitals for services; adopting similar clauses in their contracts that limit their liability in unfair and abusive ways; agreeing to cut back coverage to certain places, and using similar claims processing systems designed to systematically underpay claims.

As Hunter testified, federal authorities have recommended eliminating or cutting back the antitrust exemption for health insurers and medical malpractice insurers on at least four different occasions after studying it. But Congress has never taken that step, presumably due to the power of the insurance industry lobby.

With the soaring cost of health care now in the spotlight, this may finally be the right time.

Take this latest one Sam Stein reports on for The Huffington Post, showing that 77 percent of Americans think it’s important to have a “choice” between government-run health insurance and private coverage.  That poll comes from Survey USA. Meanwhile, Rasmussen Reports  found just 34 percent of Americans support a health care reform plan without a public option. Okay — so far, so good.

So how is it that Rasmussen’s last poll on health care reform found that only 42 percent of voters supported the Democrats’ proposed health reform plan, when that plan still clearly included a “public option”? Back then (last week), the whole Democratic proposal for health reform was sinking, leading President Obama and some members of his administration to start backing away from the government-run option and proclaiming their newfound flexibility.

Well, that Rasmussen poll referred to the Obama plan as simply “the health care reform plan proposed by President Obama and the congressional Democrats.” It seems significant that none of the Rasmussen questions included the word “choice” in them. And as pollsters for NBC found earlier this week, without the word “choice,” only 43 percent of the public favored “creating a public health care plan administered by the federal government that would compete directly with private health insurance companies.”

Meanwhile, another Rasmussen poll earlier this month found that “51% of the nation’s voters fear the federal government more than private insurance companies.” I guess that’s when they’re not offered a “choice” between the two.

If this confirms anything, it may be that Americans just don’t like to commit. MoveOn.org, which commissioned the SurveyUSA poll and supports the public option, was wise to that.

Still, as Stein notes, when read an actual description of the president’s health care plan (when it still included the public option), 51 percent of SurveyUSA respondents said they “favored” the approach; 43 percent opposed it. Asked the same question by NBC and the Wall Street Journal, 53 percent of respondents said they favored the president’s plan, and 43 percent opposed it.

Which, as Washington Post columnist Michael Kinsley points out today, makes the new ad campaign from America’s Health Insurance Plans (the industry’s mouthpiece in Washington) just that much more cynical.

“Illness doesn’t care where you live,” the ad says, “Or if you’re already sick. Or if you lose your job. Your health insurance shouldn’t either.”

The ad sets a scolding tone, Kinsley writes, “as if describing some dreadful situation on the moon that they [insurance companies] have nothing to do with.”

If the health insurer industry shouldn’t discriminate against the disadvantaged, as the ad says, then “why does it?” Kinsley asks.

The industry lobby says, as part of health-care reform, that it will stop caring whether you’re already sick. But why wait, now that the scales have fallen from their eyes?

Good questions, all. And the answers can be found in the companies’ quarterly reports.

The Minnesota Independent has the details.

At certain levels. President Bush’s — it’s a carryover, actually, from President Bush where he suggested that people who — companies that provide more than $11,500 worth of health insurance, that to the extent it exceeds that number. So it’s a very rich plan that the rich — that the high-end people end up paying, that that be included in income.

And that’s reasonable, in my opinion. I mean, reasonable health insurance prices should be excluded from income, but when you get into high — high-end plans, why should everybody be paying for those?

It’s unclear, at this early stage in the year’s health reform debate, how many of Gregg’s GOP colleagues agree.