Tuesday, September 29, 2009

Senate Finance Committee Rejects Public Option Amendments - So What Now?

Democrats on the Senate Finance Committee were prepared to offer three versions of the public option today (Sept. 2). Chuck Schumer (D-NY) was the sponsor of two of the alternatives - one he called the “level playing field” option. Under this plan providers would be able to negotiate reimbursement rates with the public insurer and voluntarily choose to participate in the program. This option would be required to be fully funded via premiums and even generate a reserve fund in case premiums proved to be to low. No tax dollars could be used to support it. Schumer's other amendment would have replaced the current bills plan to create insurance co-ops with the public option alread in the Senate Health, Education, Labor and Pensions (HELP) Committee's version of the bill. In that bill, the secretary of Health and Human Services would have the power to negotiate reimbursement rates. The final public option amendment was sponsored by Jay Rockefeller (D-WV), under his plan providers would be paid a rate no more than 5 percent above Medicare rates (Medicare pays less than private insurers).

Rockefeller's amendment was the first one on the block and it was defeated 15-8, with 5 Democrats joining all 10 Republicans to defeat it. The 5 Democrats were Committee Chairman Max Baucus (D-MT), Kent Conrad (D-N), Tom Carper (D-DE), Bill Nelson (D-FL)and Sen. Blanche Lincoln (D-AR). In the end, Schumer introduced his level playing field option and it was defeated 13-10 - with Baucus, Conrad, and Lincoln voting "no."

There remain three opportunities for the public option to re-emerge. 1) Once the Finance Committee reports its version of the Health Reform bill, Senate Majority Leader will merge it with the Senate HELP Committee's version - Reid could simply keep the HELP version's public option and drop Finance's co-op alternative. 2) On the Senate floor the bill could be amended to include a public option (that would require 60 votes to overcome a certain GOP filibuster). 3) If the House passes a public option and the Senate does not, the House version could be adopted in the Conference to reconcile differences between the two bills.

So three chances remain, but today's votes in Senate Finance make it clear that the public option cannot pass the Senate under normal rules of process where 60 votes are needed. The only way to pass a public option is via reconciliation - an option created in 1974 solely for resolving issues related to the deficit. NBC's First Read offers a great synopsis of the reconciliation and why it is an option of last resort - essentially, opponents could move to strike every provision in the bill not directly related to taxing and spending - the resultant bill would look like a puzzle missing half of its pieces. All of those missing pieces would be assembled into a new bill that could not rely on reconciliation and would face the 60 vote barrier. In an interesting historical side note, President Clinton and Democratic leaders considered using reconciliation to pass the Health Security Act in 1994 - but Robert Byrd (D-WV) refused, stating that such an important issued deserved a full and public debate.

The public option is not dead... but it may want to consult one of those death panels for some end of life counseling.