Thursday, May 14, 2009


As Republicans gear up to attack Democratic-sponsored reform proposals as “putting the government in charge of your health care,” today’s closed-door Senate Finance Committee meeting is focusing on the controversial public plan issue.

Senate Finance members will be looking at four specific options:

1. A single national Medicare-like plan, administered by a new agency within HHS, and most likely with start-up funding from a separate appropriation. All Medicare providers would be required to participate in the plan, and payment rates would probably be tied to those of Medicare.

2. A single national plan, established and administered by regional private sector TPAs, who would also determine provider payment rates. Generally this plan would be required to comply with the same regulations as private sector plans.

3. Multiple state-operated plans, perhaps based on existing state employee plans.

4. No public plan.

It’s anyone’s guess which, if any, of these options will find its way into the final bill, but with Finance Committee chair Max Baucus still proclaiming his desire for bipartisan support, the third option may have a lot of appeal, especially if the decision to offer such a plan is left up to the states.

On the other hand, the second option will attract more enthusiastic support from Democrats, with new-Dem Senator Arlen Specter—previously a strong anti-public-plan voice—already saying that it’s a possibly acceptable compromise.

Don’t expect a final decision anytime soon. As the Committee and the Obama administration grapple with issues of how to finance reform, it’s still possible that cheaper (like option number one) may trump political acceptability.

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