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

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 reported last night.

For public option supporters, there’s a clear advantage to 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 disapproval of 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 reportedly leaning 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-in approach 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.