A “Public Option Compromise” That’s Not?

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If the weekend is any guide, the Senate health reform bill is not likely to undergo much tweaking. Between Friday and Sunday, despite hours of debate on the Senate floor, the only amendments that passed were those from Democrats simply reiterating things the bill already calls for. One sponsored by Sen. Sheldon Whitehouse was a “sense of the Senate” amendment to reiterate that funds collected by a new long-term care insurance program would be used only for that program. It passed 98-0. Sen. Debbie Stabenow’s amendment reiterating that Medicare Advantage plans will continue to include standard Medicare benefits as defined by law passed 97-1. And an amendment from Sen. John Kerry that passed 96-0 reiterated the Democratic position that home health benefits will not be cut by the Senate bill.

Amendments that would have altered the bill were all voted down, including proposals to scrap huge sections entirely and provisions to limit the tax deduction for insurance company executive employees and cap plaintiffs’ lawyers’ fees in malpractice cases. Nope, the real health reform action over the weekend was elsewhere – off the Senate floor and far away from the C-SPAN cameras catching the all-too-familiar debate points.

As Jay Newton-Small reported, President Obama trekked up to Capitol Hill on Sunday to rally the Democratic caucus behind closed doors and offer up a “dose of inspiration.” And elsewhere, a group of Democratic senators was reportedly hammering out yet another “public option compromise,” albeit one appears – at least from my reading – unlikely to satisfy any true public option diehards.

According to Politico, the new proposal would create an exchange of non-profit private insurance plans within a to-be-created national exchange. There would be no government-run plan at all. (The Senate bill currently calls for a national government-run plan that states can opt out of.) The non-profit exchange would be modeled on the Federal Employees Health Benefit Plan, which is where federal employees – including members of Congress – currently can choose from among an array of private health plans. (An exchange is basically an electronic marketplace where insurance plans can be reviewed, compared and sold. Under the Senate bill, a new state-by-state exchanges would be established and would be limited to individuals and small businesses – at least initially.) Details are still scant, but it’s unclear how this new exchange within an exchange would be a “public option,” other than the fact that it would reportedly be administered by the federal Office of Personnel Management. Public options supporters are certainly skeptical. Writes Jacob Hacker, a Yale political science professor, health policy expert and public option champion, over at The New Republic:

…Another, even stranger idea is to offer the nonprofit plans available in the Federal Employees Health Benefit Plan (FEHBP) within the exchange. Since the FEHBP is itself a form of exchange, this amounts to offering a new set of private plans within a new set of private plans. How is that going to provide real pressure on private insurers in a consolidated insurance market in which nonprofit plans already have a large presence (and often act little differently from for-profit plans)?

A poster at Daily Kos agrees:

It’s not a public option. It’s essentially an exchange within the exchange. Now maybe it’s a good substitution for the exchanges–just open up the FEHBP to people instead of creating, in the House’s case a national exchange, or in the Senate version multiple exchanges….But it’s still not a public option, like most of the “compromises” we’ve seen floated in the Senate.

The goal of all of these so-called “compromises,” of course, is to come up with a plan that moderate Democrats who oppose a real public option can get behind, without alienating Democrats for whom the public option is a deal breaker.

Senators are back on Monday and moderate Democratic Sen. Ben Nelson is reportedly planning to offer his “Stupak-like” amendment related to abortion coverage.

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