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.