Health Care

The Public Option Could Be Back. No, Really…

By Karen Tumulty | March 15, 2010 | +

Nope, you won’t see a public option in the legislation that is expected to come to a vote in the House later this week. But if it passes, we may well see a public option established in some–maybe many–states.

As Kate and I have written before, if this bill becomes law, states will be on the front lines of health reform. What they do will likely be the difference between whether this whole endeavor succeeds or fails. This morning, at the invitation of the National Governors Association, I moderated a health reform roundtable of four Governors: Democrats Ted Kulongoski of Oregon and Joe Manchin III of West Virginia, and Republicans Jim Douglas of Vermont and Mike Rounds of South Dakota. Their insights were important and revealing.

Here’s one that surprised me: Governor Kulongoski said one of the first questions he will confront is the issue of setting up a public option as part of the state “exchanges” that would be required under the new law. Kulongoski supports a public option. And in his state, work on the feasibility of one is already under way. Oregon’s HB2009, passed last year, includes this direction to the state’s new Health Authority:

Develop and submit a plan to the Legislative Assembly by December 31, 2010, with recommendations for the development of a publicly owned health benefit plan that operates in the exchange under the same rules and regulations as all health insurance plans offered through the exchange, including fully allocated fixed and variable operating and capital costs.

Afterward, I asked Douglas and Manchin whether their states might also be giving serious consideration to a public option. Douglas said no, but Manchin insisted: “All of us are going to have to look at that. … What we’ve got to do is make [insurance companies] compete–and a public option is probably the only way.”

In a broader sense, this reminds us that, for all the talk of this bill imposing a “one size fits all” health care system on the country, the reality could be very different. If and when President Obama signs the health care bill into law, the action moves out to the states, where many of the same political battles are going to be fought once again–and possibly, with a very different result.

Related Topics: governors, jim douglas, joe manchin, mike rounds, public option, ted kulongoski, Health Care

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  • dwilde1

    Thank you, Karen. That’s the way things are supposed to work in America. States try things out and watch over each others’ shoulders. People vote with their feet. The best options get copied. :D

  • 53_3

    Wolf! Wolf!
    .
    Oh wait.
    .
    Wasn’t there a childrens’ story about this?

  • charlieromeobravo

    “In a broader sense, this reminds us that, for all the talk of this bill imposing a “one size fits all” health care system on the country, the reality could be very different.”

    Heh. What is being claimed about many details of the health reform bill is radically different than reality. That’s been the case from the first day this project kicked off.

  • madhuryarasa

    Without the Kucinich amendment in the health care reform bill (which is currently omitted and has been for some time), states that attempt to implement a single payer health system would be subject to lawsuits.

  • stuartzechman

    Please, could you supply links and quotes that support this claim?

  • freeinpa
  • stuartzechman

    KT:
    .
    Given that this legislation is essentially Bob Dole’s health care plan from 1994, of course it isn’t “imposing a “one size fits all” health care system on the country,” it merely lets the state-based insurance cartels run the show where they have enough power to do so.
    .
    Hmmm…isn’t Kulongoski from Oregon, along with Sen. Ron Wyden, he of national exchange bill fame?
    .
    …And isn’t Manchin from West Virginia, the state from which Sen. Jay Rockefeller, the champion of the public option in Baucus’ Finance Committee, hails?
    .
    I guess the question isn’t what the exchanges will look like in Oregon or West Virginia –or Massachusetts, for that matter– the question will be what these things look like in the states that are already at the obvious mercy of their local insurance cartels or monopolies.
    .
    Why is it remarkable that one state might have a “very different result” than another under this legislation? Isn’t that part of the whole problem with health care, KT?
    .
    Aren’t we just right back to McAllen, TX vs El Paso, TX again?

  • Ivy_B

    The HuffPo link from November discusses state’s enacting single payer plans, not a public option. It seems these would have replaced the HCR plan.
    .

    The amendment to allow states to individually implement single-payer was sponsored by Rep. Dennis Kucinich (D-Ohio) and passed the Education and Labor Committee’s version of the health care bill. There were shenanigans involved, with Republicans joining Kucinich not because they supported the bill but because they wanted to create mischief. (Asked about the GOP position, Rep. Mike Pence (R-Ind.) said that the party’s opposition to single-payer health care trumps its support of states’ rights.)

  • http://twitter.com/ktumulty Karen Tumulty

    Ivy_B: Good point, and that’s an important difference. What these guys are talking about is an option that would operate alongside private insurance companies in their state exhanges. And the Oregon law seems to stipulate that what they are studying is the weaker version of the public option that we saw in the House bill, not the so-called “robust” public option.

  • mikew67

    Add a .50 tax to every fast food order which exceeds 500 total calories. With the millions of those sold every day in America, that would help illuminate the issue, discourage the consumption a little, and toss billions of dollars into the kitty to finance health reform — saw a cool site; Balkingpoints ; incredible satellite view of earth

  • stuartzechman

    Don’t visit this site, don’t support blatant blog-whoring bots.

  • stuartzechman

    Thanks so much for the link.

  • http://kellysalasin.wordpress.com kellysalasin

    Thanks for the windows of possibility. Now, if we can just replace Douglas in VT.
    http://thisvtlife.wordpress.com

  • http://will110256.wordpress.com will110256

    I do hope you know that single payer and public option are not the same thing.

  • brmull

    KT- How does even a “level playing field” public option get past ERISA, which prohibits states from offering insurance in the employer market? In the country as a whole the individual market is only 16 million people divided among dozens of insurers. So even if all 50 states somehow got together and offered insurance the market would be too small to be viable. And of course multiple states joining together on anything of this magnitude has never happened since, well, secession.

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