The partial return of the public option
Four months after President Barack Obama enacted the Affordable Care And Patient Protection Act, House Democrats have resurfaced a top liberal priority buried near the end of the grueling year-long battle over health care reform: the public option.
Armed with a new line of attack aimed at soothing deficit fears, Democratic Reps. Lynn Woolsey (Calif.), Jan Schakowsky (Ill.) and Pete Stark (Calif.) last Thursday unveiled a bill that would offer consumers the choice of a “robust” government-run insurance plan alongside the private plans in the law’s exchanges. The Congressional Budget Office projects that the bill, which has gained 128 co-sponsors, will reduce the federal deficit by $68 billion between 2014 and 2020.
“As the deficit continues to grow, so does the need for a program that can save billions of dollars and improve health care while doing it,” said Woolsey, the co-chair of the progressive caucus. “We are introducing the public option now so it will be available as a ready-made offset or deficit reducer in this or the next Congress.”
Schakowsky argues that the lower overhead costs of government plans such as Medicare would allow the public option to create a better deal for consumers. “We could offer that kind of plan at a lower cost, and it would compete with private insurance companies, who would have to be more efficient and lower their costs,” she said. “It would follow the same rules as private insurers.”
The measure is unlikely to reach the floor this year, and could face even steeper odds next Congress. If nothing else, it appears part of a concerted effort by Democrats to galvanize disenchanted progressives and attack Republicans ahead of the tough November midterm elections.
“You’re the deficit hawks,” said Rep. Raul Grijalva (D-Ariz.), referring primarily to Republicans, “and we’re giving you a tool to be able to deal with the deficit.” Grijalva labeled deficit-minded lawmakers who refuse to consider the public option “hypocrites,” alleging that “the excuse that it was going to be too expensive is phony.”
For Democrats in election mode, catering to liberal wishes could help bridge the wide enthusiasm gap among voters — a key predictor of midterm victories, where the main objective is to turn out the party base. A Reuters/Ipsos poll last month found that 72 percent of Republicans were “certain” they would vote in November, compared to only 49 percent of Democrats.
“I do think this turnout issue is really going to be the crucial indicator, and the election hangs in the balance on how many of those less-committed Democrats actually turn out again,” said Ipsos pollster Julia Clark.
“That is a very real issue that we’re focused on,” Rep. Chris Van Hollen (Md.), the head of the Democratic Congressional Campaign Committee, admitted to Reuters. Apart from the public option bill, the White House on Monday strongly hinted it will choose liberal favorite Elizabeth Warren to lead the consumer protection agency. On Tuesday, Senate Democrats forced a cloture vote on the DISCLOSE Act, also a progressive priority, despite widespread expectations that it wouldn’t pass.
Republicans, who have depicted the public plan as a slippery slope to a national single payer system, derided the attempt to revive it and dismissed the CBO report. “House Democrats still don’t get it,” National Republican Campaign Committee spokesman Paul Lindsay said. “As if it wasn’t enough to vote for their party’s overreaching health care takeover that was soundly rejected by Americans, they now have the audacity to propose a government option which would put health care in the hands of bureaucrats and further bankrupt our nation.”
The CBO estimates that the public plan’s premiums would be, on average, 5 percent to 7 percent lower than the private plans in the exchanges. Providers would be paid Medicare rates plus 5 percent, a figure that would rise alongside physicians’ costs.
“Although skepticism about big government is growing, the CBO estimate gives [Democrats] an important selling point at a time of rising concern about deficits,” said Jack Pitney, a political scientist at Claremont McKenna College.
Popular among the populace but highly controversial in Congress, the public plan has the political disadvantage of facing fierce opposition from insurance companies, which fear competition from the government. And progressives shouldn’t hold their breath for a vote. “It’s unlikely it’ll be taken up this session,” a House Democratic aide conceded, saying only that it’s “quite possible” next Congress. But is it?
“For the progressives, it’s now or never,” Pitney argues. “They know that Republicans will make big gains in 2010, probably winning the House and maybe even the Senate. The numbers favor further GOP Senate gains in 2012.”
Despite the historic accomplishment, liberals cannot help but look back on the vexing health care debate with wistfulness, if not bitterness. Even though the bill covers 30 million Americans, liberals felt short-changed by its lack of a public insurance program. While the House passed a version of a public option in its November legislation, it was removed from the Senate version due to a lack of votes, and subsequently pronounced dead. (For a few liberal activists, this was the final straw that made the legislation no longer worth passing.) One day later, a CBS poll found that six in ten Americans favored the opportunity to choose between private insurance plans and a government plan. Surveys have consistently found that a large majority of the American public support the idea.
At the time, President Obama, soothing concerns of House progressives unsure whether to back a bill without it, reportedly assured them in private that it was merely a first step and he’d be willing to return to the public option later.
But major domestic initiatives are more likely to occur early in presidential terms, Pitney noted, arguing that the measure’s chances of success during this Congress are slim – but not nil. “It’s a Hail Mary pass, to be sure,” Pitney said. “But Hail Mary passes sometimes work. And Speaker Pelosi likes the Hail Mary. And if they fail to make the effort now, they will regret it in the future. Better a Hail Mary in 2010 than an Act of Contrition in 2011.”