Congress Considers Several Choices for the Public Option

By: Stephanie Condon
Topics: Health Care

(CBS/AP/iStockphoto)

As leaders in the Senate and the House prepare to present a single health care bill in each chamber, they are not only considering whether or not to include a government-sponsored health insurance plan, or "public option" -- but also what kind of public option.

There are a variety of ways Congress could structure a public option -- and the small differences could have tremendous consequences. The form the public option takes could, for example, impact the payment rates doctors receive for their services, whether doctors in different regions of the country end up getting different rates, how much money the government could save by using the plan, or how many people sign up for it.

House Speaker Nancy Pelosi (D-Calif.) has insisted the House health care bill will include a public option, and Thursday she said the House is sending three different public option proposals to the Congressional Budget Office (CBO) to assess their financial impact. The three plans vary in the way medical provider reimbursement rates are handled.

The three options are:

1. A "robust" public option, favored by progressives and Pelosi: Medical providers would be reimbursed at Medicare rates, plus 5 percent.

2. A public option with "triggered" rates: The government would negotiate payment rates with providers, meaning the government would be "on a level playing field" with the private sector and would likely have to pay rates higher than Medicare rates. However, if costs rose to a certain point, the reimbursement rate would revert to Medicare rates plus 5 percent.

3. A public option with negotiated rates -- and also expanded Medicaid eligibility: The government would negotiate payment rates with providers, meaning the public option would not save the federal government as much money. To offset the added costs, more lower-income people would be eligible for Medicaid rather than tax credits. The current House proposal would raise Medicaid eligibility from 100 to 133 percent of the poverty line, but this compromise would expand it to 150 percent of the poverty line.

CBSNews.com Special Report: Health Care
Health Care Progress Report: October 5

Another important option that is now on the table as a way to cover the expense of reform is taxing the windfall profits of insurance companies, in addition to imposing a surtax on wealthy Americans. This is the latest idea the House has come up with to make up for the shortfall they have by raising the surtax on wealthy American from impacting families making $350,000 to families making $1 million.

"I thought that there was more that the insurance companies could contribute to this health care reform, because, after all, they're going to get 50 million new consumers, many of them subsidized by the taxpayer, and we think they can put more on the table," Pelosi said Thursday.

The speaker said the House will decide what option to include after receiving the CBO's score, which could be ready within 10 days.

Meanwhile, the Hill newspaper reports the House may be 10 votes away from having enough votes to pass a "robust" public option.

In the Senate, Majority Leader Harry Reid (D-Nev.) may include a public option in the bill he brings to the floor, even though the Senate Finance Committee rejected two variations of the idea. If he does not, it is almost certain to be proposed as an amendment on the Senate floor.

Senate leaders have considered another form of compromise, in which states would be able to opt out of a "robust" public option, the Huffington Post reports. Sen. Chuck Schumer (D-N.Y.), a strong proponent of the public option, said Thursday the opt-out plan is being "very seriously considered" and that he is "very optimistic" there will be some form of a public option in a bill that makes it to the president's desk.

CBS News Capitol Hill Producer Jill Jackson contributed to this report.

Updated at 4:50 p.m. ET to reflect that the Blue Dogs have not as a group specifically endorsed the second public option plan.

Stephanie Condon
Stephanie Condon is a political reporter for CBSNews.com.
Follow on Twitter »

20 Comments Have Your Say
Email Story Send to a Friend
Share This Tell Your Friends
Tweet This Tweet This
More Share It

Add a Comment

See all 20 Comments


by alienhairdo October 8, 2009 9:19 PM EDT: If the Dems don't give us a robust public option and don't regulate medical industry, I'm going to Opt-Out of the Democratic Party forever. And if that means Palin or Satan or Hitler will be president, I'd rather have that than be stabbed in the back by the Dems.; Reply to this comment


by reveal5 October 8, 2009 5:57 PM EDT: Reform means best treatment methods from the leading clinics and hospitals, like the Mayo Clinic will be instituted as best treatment methods in Medicare. These best treatment methods ensure better care, faster patient recovery, and lower costs for seniors and the American taxpayer who subsidizes Medicare. The Mayo Clinic is, perhaps, the best medical institution in the United States. The Mayo Clinic is a worldwide medical care icon. The best treatment methods from the Mayo Clinic , for instance, will be used as the preferred treatment methods for Medicare if reform passes. This means better treatment for seniors, faster recovery for seniors from illness or injury, and lower costs for seniors and taxpayers, in general. The Mayo Clinic knows what they are doing. The Mayo clinic delivers the very best healthcare in the world. The Mayo Clinic also delivers the best care at a lower cost. Medicare can use these treatment methods and improve senior care and reduce costs. That is what is offered for seniors in healthcare reform proposals..... better, more fiscally responsible medical care.; Reply to this comment


by reveal5 October 8, 2009 5:13 PM EDT: The majority of Republicans in the Republican party now understand that the Republicans are simply obstructing Congress.; Reply to this comment


by reveal5 October 8, 2009 5:11 PM EDT: I heard a comment on a news program that the public option would save 110 billion dollars over ten years. The comment was that inclusion of the public option would add to cost savings of reform. Reconciliation begins when the Baucus bill clears committee. Republicans are now being prodded by other important current and retired republicans, like Bob Dole and Bill Frist,to get with the program and to stop obstructing progress on healthcare reform. The public and doctors want reform to include a public option. The repubs are coming under increasing pressure to stop playing to the fringe. It is possible that some repubs will respond to these pressures.; Reply to this comment


by jschmidt27 October 8, 2009 5:04 PM EDT: Pelosi will sink the Baucus bill when the public option is added. Baucus bill may ne the way to go but it will not fix the cost of healthcare, just make the doctors and hospitals suffer.; Reply to this comment

by jschmidt27 October 8, 2009 5:02 PM EDT

THis is the Dems show and they;ll pay the consequences in 2010. Discussing common sense issues with Dems is frustrating. The see no other choice than their own.

Reply to this comment


by stuart-johns2 October 8, 2009 5:41 PM EDT: I trust you don't talk to yourself in mirrors all the time do you? Do you have a "mission accomplished" bumper sticker attached to your mirror?


by stuart-johns2 October 8, 2009 4:54 PM EDT: I love that comment Joe Scarbourough this morning. In a conversation with another republican who was antagonistic and refusing to answer a question, joe said, "Well it seems that some of the adult members of the republican party are coming out in support...."

What an excellent dig! I loved it!; Reply to this comment


by hungry1968-16 October 8, 2009 4:43 PM EDT: by Majesty_Command October 8, 2009 4:37 PM EDT
stuart, we have 3 more years to suffer under "Obama the failure".
After that , a democrat will not be able to buy votes. The republicans
will regain control and fix the mess Obama and his anti-Americans
followers have got us in.

7 More years of Obama.

And by then, the republican party will be disbanded and have gone the way of the Whigs.

The two big parties then, will be the Democrats and either the Libertarians or the Green Party.; Reply to this comment

by hungry1968-16 October 8, 2009 4:41 PM EDT

by Majesty_Command October 8, 2009 4:19 PM EDT
I'm happy to be the one to break the news to you.
NO NO NO , the vast majority of the American pewople
are against government controlled health care. Yes , people
want health care reform, not government control.

YOU are the only person that talks about a "take over" of health care.

Why do you keep making that up?

Reply to this comment


by rmonroe401 October 17, 2009 1:08 PM EDT: No true hungry1968-16. The majority of people are for the public option, and in some parts of the country the majority are for single payer. You must get your numbers from Faux News, the misinformation channel.


by stuart-johns2 October 8, 2009 4:29 PM EDT: by hungry1968-16 October 8, 2009 4:21 PM EDT
You're watching MSNBC too, huh?
==============

At this time of the day....always hungry...always.; Reply to this comment