This week the Blue Dogs made a splash releasing their demands for what a public option couldn't be in health care reform:
Among their requirements: The public plan must negotiate payment rates with providers; participation in the plan must be voluntary for both providers and patients; premiums and copayments under the plan must pay for its operations; and the plan must follow the same actuarial standards and regulations required of private insurers.
The 51 Blue Dogs are slamming up against the much larger Progressive Caucus, which released its requirements for a public option in a letter sent today to House leadership. It reads, in part
The Congressional Progressive Caucus (CPC) stands united in the call to provide high quality, affordability, and accessibility in healthcare choices for all Americans. As you are aware, the overwhelming majority of CPC Members would prefer a single-payer approach. If a single-payer plan is not enacted, we agree with President Obama that there must be a robust public health insurance option like Medicare offered alongside the private plans....
The CPC believes the public plan should provide a guarantee of coverage, affordable, high-quality and accessible healthcare, and lower costs regardless of income, health status, race, employment, or gender. We strongly oppose any conditions or triggers undermining and limiting the availability of the public option.
In addition, they provided these requirements:
The Congressional Progressive Caucus calls for a robust public option that must:
- Enact concurrently with other significant expansions of coverage and must not be conditioned on private industry actions.
- Consist of one entity, operated by the federal government, which sets policies and bears the risk for paying medical claims to keep administrative costs low and provide a higher standard of care.
- Be available to all individuals and employers across the nation without limitation
- Allow patients to have access to their choice of doctors and other providers that meet defined participation standards, similar to the traditional Medicare model, promote the medical home model, and eliminate lifetime caps on benefits.
- Have the ability to structure the provider rates to promote quality care, primary care, prevention, chronic care management, and good public health.
- Utilize the existing infrastructure of successful public programs like Medicare in order to maintain transparency and consumer protections for administering processes including payment systems, claims and appeals.
- Establish or negotiate rates with pharmaceutical companies, durable medical equipment providers, and other providers to achieve the lowest prices for consumers.
- Receive a level of subsidy and support that is no less than that received by private plans.
- Ensure premiums must be priced at the lowest levels possible, not tied to the rates of private insurance plans.
In conclusion, the public plan, like all other qualified plans, must redress historical disparities in underrepresented communities. It must provide a standard package of comprehensive benefits including dental, vision, mental health and prescription drug coverage with no pre-existing condition exclusions. It must limit cost-sharing so that there are no barriers to care, and incorporate up-to-date best practice models to improve quality and lower costs. All plans, including the public plan, must include coverage for evidence-based preventive health services at minimal or no co-pay. All plans, including the public plan, should be at least as transparent as traditional Medicare.
The Senate is taking the lead on health care reform, but it can largely be shaped by what the much larger Democratic caucus in the House will agree to. The Progressive Caucus has the numerical advantage to pass or kill any provision, and it's very good to see them pushing their weight around on this one.