Trigger Happy

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Senate Majority Leader Harry Reid has said he will include a public option that states can vote to opt out of in his version of the health care reform bill that could be unveiled as early as Wednesday. But that certainly hasn’t ended the debate in the Senate about what kind of public option may finally end up passing the upper chamber and if you talk to centrists the only word you hear is trigger: there’s the Snowe trigger, the “hair” trigger and something Senator Tom Carper, a centrist Delaware Democrat, is calling the “hammer.”

Carper is trying to build centrist unity around his idea in order to offer it as an alterative if and when the opt-out public option fails – a provision, he says, that just doesn’t have the votes to pass the Senate. “We’ll see what comes out of Reid’s bill but I think at the end of the day we may need something along the lines of what I’m suggesting in order to finish debate on the bill and report [the bill] out,” Carper said.

Carper is meeting with centrists such as Joe Lieberman, Olympia Snowe, Mary Landrieu, Ben Nelson, Evan Bayh and Blanche Lincoln asking them what kind of a trigger they might vote for. “What we’re asking centrists is: ‘What concerns do you need to have addressed to vote for cloture?’” Carper said. “And the two concerns that we hear over and over again is government run and government financed.” Both the hair trigger –which measures market penetration  (an idea panned by at least one centrist, Nelson) — and Snowe’s trigger would institute government run public options on a state-by-state basis. In order to avoid direct government involvement, Carper is suggesting a national co-op.

The day the exchange is created states would have to meet an affordability test. Those that fail would be forced to compete with a non-profit co-op, based off of Senator Kent Conrad’s original idea. The co-op board would be appointed by the President and confirmed by the Senate. There would be an angel investment footed by the taxpayers to be eventually repaid and reserves set to protect against taxpayer bailouts. That said, the details of the plan are still sketchy: such as what defines the affordability trigger (TBD “by people smarter than me,” Carper said), how much will be needed in seed money, whether the Department of Health and Human Services should be involved and if states could eventually leave the co-op if they met certain qualifications. But, Carper argued, the plan is stronger than his previous suggestion – where states could elect to opt-in to a national government-run public plan. “Opt-in suggests it’s voluntarily but with the hammer approach those states would have to opt-in on day one,” he said.

The plan, on paper, would overcome Lieberman’s objections to a government-run competitor to insurers and would seem to fit Snowe’s criteria for a trigger. But, this is all a work in progress, Carper said. “Everyone will have a chance to see it and to offer suggestions.” The most important thing, he added, is to find a compromise that can garner 60 votes in the Senate. Such an idea might make centrists happy, but it’s sure to anger progressvies who thought Snowe’s trigger — which created an actual public plan — was already too weak. Reid’s challenge will be appeasing Carper’s group while holding everyone on the left. And that might take a while.

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