Public option may be on life support

Progressive groups say an alternative plan won't work, but the Senate pushes for a way around an impasse

Published December 8, 2009 11:01PM (EST)

Dropping a public insurance option from the healthcare reform bill is now, conventional wisdom has it, supposed to be the trick that gets the legislation the 60 votes it'll need to pass the Senate. But the talks aimed at figuring out what to replace it with and how to move things along hadn't yet reached any new agreement by late Tuesday -- and key progressive groups that have been staunch supporters of the public option say the alternatives under consideration won't fly.

Two groups of Democratic senators have been meeting since Monday to try to hash out a deal to replace the public option -- five liberals and five moderates. Instead of a government-run insurance plan in the healthcare exchanges that the reform bill would set up, the new scheme would let people who don't have employer-provided insurance buy into new national insurance plans supervised by the federal agency that handles health benefits for government workers, the Office of Personnel Management. The details of how that would work -- how OPM would negotiate with insurance companies to set the premiums, how many people would be expected to enroll, how vigorously the plans would pursue cost controls with providers -- are still all up in the air. Besides opening the federal plan up, uninsured people between 55 and 64 could also buy into Medicare, usually restricted to people 65 and older, though it's not clear how much the government would charge them to do that.

This new plan seems to be picking up steam among moderates, but progressives aren't thrilled by it. "We don't believe that substituting a collection of private plans for a public health insurance option is a compromise," said Jacki Schechner, a spokeswoman for Health Care for America Now, a coalition of progressive groups and labor unions that came out firmly against the alternative plan Tuesday. HCAN supports expanding Medicare, but doesn't think that's an acceptable alternative to a real public option, either.

But the public option may not be an option for much longer, the way things are heading in the Senate. Enough conservative and moderate Democrats have said they won't vote for a bill that includes a public plan that leaders may not have much choice but to jettison it. And while progressives say they don't like the alternative plan, no members of the Senate or major liberal groups have come out and said they'd oppose the overall reform bill without the public option.

Talks are still ongoing, though, and lawmakers participating in them wouldn't say where they think things will end up. "There's no deal on anything," said Sen. Sherrod Brown, D-Ohio, an outspoken public option supporter. "Nobody agrees to anything. The public option is still in the bill. I'm not willing to concede anything" until the talks wrap up.

Time is running out, though. Senate Majority Leader Harry Reid still wants to pass a bill by the end of the year, which doesn't leave much room to let these talks drag on much longer. Asked Tuesday when he would begin to take the next parliamentary step to move the legislation along in the process, Reid just shook his head grimly: "As soon as I can."

By Mike Madden

Mike Madden is Salon's Washington correspondent. A complete listing of his articles is here. Follow him on Twitter here.

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