There are competing state-based public options in the news today. The first, and the one rumored to be favored by Senate leadership to create a weak public option when the SFC and HELP bills are merged is allowing states to create their own public options.
In a press conference this morning with other Democratic senators, Sen. Debbie Stabenow (D-MI) -- member of the Senate Finance Committee and a supporter of a robust public option -- says it's a "broad definition."
"The states are one way to go," she said
Sen. Robert Menendez (D-NJ), who also sits on Finance and supports a public option as enthusiastically as Stabenow does, added, "There are state options that are devised in such a way that only a region of the state is included, in which case that's not really a significant public option."
"If the whole state is included in a public option -- they have that option -- well that's a much more significant standard than some that have been proposed," Menendez told reporters.
The "states" option, forwarded by Carper, is gaining ground among the usual suspect ConservaDems, according to a WSJ report:
"Conceptually, having the states take responsibility makes a great deal of sense," said Nebraska Sen. Ben Nelson, a key voice for moderate Democrats. "It is important that we really take a close look at this." He noted that states are already in the health-insurance business because they administer Medicaid and other federal-state programs. Mr. Nelson said state health plans could compete alongside the nonprofit cooperatives. Another Democratic centrist, Sen. Kent Conrad of North Dakota, said the Carper proposal was "very constructive."
It's very constructive if you want to kill an effective public option, and in that sense is just as constructive as the Snowe trigger. It creates 50 different ways to deliver health care, and maintains a splintered system that cannot effectively reduce costs. In face, as Igor Volksy at the Wonk Room points out, "in the 30 states that already provide their employees with coverage through so-called mini public options or co-operative options, health care costs have not decreased. They’ve increased."
So if ConservaDem senators are so concerned about the public option in their states, why not do the reverse--create a strong public option and allow states to opt out of it? Actually, that's an option being floated.
Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program.
The proposal is envisioned as a means of getting the necessary support from progressive members of the Democratic Caucus -- who have insisted that a government-run insurance option remain in the bill -- and conservative Democrats who are worried about what a public plan would mean for insurers in their states.
"What folks are looking for is what gets 60 votes," said a senior Democratic Hill aide. "The opt-out idea is very appealing to people. It has come up in conversations. I know personally that a handful of members have discussed it amongst themselves."
In terms of national policy, is this necessarily a good idea? Probably not, when you've got crazy secessionists like Rick Perry in governorships. The thought of all those Texans not having access to care is a problem. On the other hand, how many governors ended up sending back those stimulus checks? How many governors, state legislators, or even Senators of Nebraska or North Dakota or Arkansas are going to be willing to stand in front of their constituents and tell them that the rest of the country has access to a government option for their healthcare. Have at it, Ben Nelson.
This could make political sense. What they're talking about is a robust national public option, one that would be set up to be successful. If giving governors the opportunity to turn it down is the compromise we need make a strong, federal public option operating the majority of the nation, it might be worth a look. It's certainly better than Carper's alternative, creating fragmented state options. It's better than co-ops or triggers, or even Schumer's level playing field.
(TomP has more on the opt-out alternative.)
