Carper’s State-Based Public Option Gains Steam
Tom Carper’s hybrid state co-op/public option plan is gaining momentum in the Senate right now. If you want to know what to think about the plan look at who’s praising it.
A new proposal by Sen. Tom Carper would spell out how to boost competition in the private market by enacting government-run plans at the state level. States could act alone or in concert with others to gain more leverage in the marketplace, and would be bound by the same rules established for private companies using the national insurance exchange envisioned by the Senate Finance bill. Another option would entail states opening their workers’ employee-benefit plans to the general public.
The Delaware Democrat’s plan won praise from some in his party Tuesday as a way of bridging differences among them.
“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.”
Ezra Klein, who has been a really good resource to understand the various proposals likes the plan.
[…]each state would have the option to:
1) Participate as grantees in the CO-OP program and apply for seed funding.
2) Open up that state’s employee benefits plan.
3) Create a state administered health insurance plan with the option of banding together with other states to create a regional insurance compact.
Each state would, in other words, be allowed to create a public option. And states could band together to give their public options more bargaining power and efficiencies of scale. This would do a couple of things. First, it would give residents access to a public competitor. Second, it would provide an acid test of whether a public competitor substantially changes an insurance market. Does it force private insurers to bring their prices down? Does it create more competition and transparency? Are consumers more satisfied? And if all that happens, will other states really resist adopting the public option?
To me it looks like the Co-op plan, and the main criticism of co-ops is that the co-ops are too small and too weak to effectively compete with the insurance giants. Regional co-ops are probably better than state to state options but are still small and relatively weak. I see this proposal as the public option in name only.
At this point I just want something to come out of the Senate with a public option. I think this may be the best we can hope for, and hope that the public option gets strengthened in the House-Senate conference. Once it gets out of conference, there are only 50 votes needed in the Senate (Biden breaks the tie).
Tags: Health Care Reform, Tom Carper
I think the bottom line on this is, “It’s (marginally) better than nothing”. From my unexpert perspective, I see two big problems. One is that, as of the last I saw, these “state public plans” would be barred from linking reimbursemnet rates to Medicare, even with a percentage added on. This means they have no real way of holding down costs. The second flaw is leaving the decisions up to the states. There are currently 22 states with Republican governors. Even CA aside, how many Americans will be left out of this “solution”?
As I said, the best thing I can say about it is that if this is the only way to pass any sort of a public option, at least it’s something. And it opens the possibility of strengthening this weak solution down the line.
Yes, leaving out people who need the option the most is bad. I wonder if the uninsured in those states will be able to buy into a plan from a neighboring state?
The lawmaker we really need to be watching right now is Wyden. Wyden had an amendment that Baucus didn’t introduce to open up the exchange and the public option to everyone who wants it. Right now people are locked into their employer-based plans. I think a really big worry with the state-based co-ops is that it will be filled with sicker people which would make it difficult to control costs and be competitive.
You left out one option for the states: 4) do nothing.
Because state legislatures are basically whorehouses, the better name for this, at least among insurance companies, is “Divide and Conquer.”
I agree with Geezer — the Carper amendment has plenty of the promise of letting states do what they like but when you look hard at it there are lots of problems of solving the cost control problem. After you’ve solved the problem of just creating the co-op in the first place.
Medical co-ops exist and are doing good work in a few places. But where they exist they do not contribute to lowering regional costs. They do contribute to upping the quality of care, however. I think of this state-option co-op as another version of a useless trigger.
The Carper Amendment written by the insurance companies just like Baucaus…is DOA. Why isnt the democratic party taking the position of those going after Baucaus. That states Democratic Party are telling him get on board or your done. The unions in the State of Delaware if they had any cahones at all would be challenging Carper and his ridiculous plan. Carper is caught in the trap of his own making. Taking all that money from the insurance companies to block the public option, fighting his own party, and standing solidly against the majority of citizens.
Doctors dont want the Carper plan either. In order for Carpers plan to work, the doctors would have to sign on to all those for profit plans. The doctors are opposed to a continuation of the current system that takes 40% of their time doing paperwork and arguing with the insurance companies who over rule their plan of treatment.
I wonder how many Doctors/Nurses/Health Care professionals Carper has met with? None!
How can the citizens of Delaware continue to vote for this carpetbagger republican when he is doing exactly the opposite of the majority of citizens?
There is a bill in the State Legislature for single payer SB 120. Harris McDowell took the sponsorship but has done nothing to get it out of committee or scored? If you think there are problems getting the Congress/Senate to agree on a solution…what the hell do you think the corporate lobbyists in Delaware would do should our State decide to get their own plan. The Chamber of Commerce, and repuke think tanks, big pharma et al would be filling the coffers of our legislators just like they have on the national level.
Carper should be thrown from office. The Democratic Party, the unions should send him a heavy statement, get on board with the Party, or we will not give you a dime for your next election. That is the only thing that will change Carpers mind.
Here’s a horror story for ya. A woman I know has breast cancer. She had to get medicaid. She has had two surgeries and needed to remain in the hospital for after care. Under the Delaware State MEdicaid plan she was forced to leave immediately after surgery. She had a major infection while at home with temps at 103.9. She had to have another surgery this one even more invasive. Again, they are throwing her out of the hospital immediately after coming out of recovery. This is the State Plan Carper thinks is good for Delaware. You should look at the DHSS Medicaid plan and see how high the numbers are. The taxpayers cannot sustain these high costs. As more citizens loose their jobs, they go to Medicaid for “peasant care”.
This is what Carper wants for all Citizens? The Co-op cost $12M for startup…that is more money wasted that should be used to provide care. Carpers plan is nothing more than a continuation of the huge profits for insurance companies, giving them another 47million people subsidized by the federal government.
Can’t you liberals get with the progressives in Congress and stand strong for a real public option that will bring down costs, instead of flip flopping everytime some right wing nut comes up with a plan to destroy the public Option. That why you are liberals, not progressives. Liberals talk a game but never follow through with a real plan of action.
The really sad thing is that this is being talked about as a viable alternative at all. There should not be a fall-back, compromise position from the public option. The public option is the compromise position. The problem is that it was never framed that way from the beginning.
The bargaining should have begun seriously at single payer. Once you establish that as the legitimate (not fringe) left position, then you bargain down to a public option. The error made by the administration at the start was to think that there was ever any way to get any real Republicans to vote for anything Democrat-introduced. The negotiations should have been between the farther Left and the moderate Left from the beginning.
Government run health care – the so-called “public option” – presents serious challenges for us. The private sector and competitive market forces are the best means to meeting health care needs. Watch this video from the U.S. Chamber http://www.friendsoftheuschamber.com/media/
“private sector and competitive market forces” are what we have now, and are what caused the mess we have now. Unless you think they are meeting our needs sufficiently, in which case there’s nothing more to discuss.
Also, the US Chamber of Commerce is a business lobbying group, and one who is currently losing members due to their refusal to accept the realities of climate change. So you’ll excuse me if I don’t put a lot of stock in what they say.
And it’s a shame to still have to say this after all this time, but if you really think a public option is “government run health care”, you’re either uninformed, easily manipulated, or a little slow. If you don’t really think that and are just saying it, then I’ll be nice and not say what you are.
Scott: we all have to wrap our heads around one fact. Both parties are corporate snakes. Both parties taking campaign contributions from the bankster/gangsters, big pharma, credit card and insurance companies. Both parties support multi national corporations. We no longer have a democracy, we have a lobbyocracy and we the people, for the people, by the people are loosing!
The only solution is demand Campaign Finance Reform. It should be illegal for any candidate regardless of the race to only accept contributions from the citizens IN THAT STATE. Until then we are whistling against the wind.
A2: I don’t dispute that there is a lot of truth in what you say. As for the Campaign Finance Reform you mention, it has its merits, but will never happen for one reason. It hurts incumbants much more than challengers. I have a hard time seeing Congressmen enact legislation that makes it easier for them to get beaten.
The CBO scored the co-ops and they did not fare too well. Wonder if they’ll score the Carper version?
I think it’s important to make a few things crystal clear in defining the Health Care reform debate.
I’ve been actively engaged in the discussion at the state level and the federal level for more than 4years now. I testified on behalf of HB 62, (a State Single Payer bill), authored by Dr. Floyd McDowell and sponsored by State Rep. Dennis P. Williams. It was presented before a Banking/Insurance Committee chaired by former Rep. Donna Stone and had about 60 people in attendance although the numbers dwindled as the committee continued with an agenda of innocuous items until approximately 6PM. At that time most committee members had left. There was not a quorum present for further action and that seemed to be the point of the delay. However as the testifier on behalf of A Philip Randolph Institute and joined by those steadfast supporters of “true” Health Care Insurance Reform it was apparent that this was a significant moment since this type of legislation had never before, nor since, been given a public vetting before a Delaware legislative committee. As a civilian activist this moment gave me a distinct perspective of how public enthusiasm can be dampened and disregarded and may have been the deciding moment of commitment to politics for me. With Rep J.J. Johnson I have sponsored a resolution in support of the Federal legislation known as HR 676, a Medicare like single payer program to insure all Americans from cradle to grave. This resolution did not get out of committee either.
The point I’m trying to make now is that we must not succumb to the false and misleading positions that are the munitions of the pharmaceutical and insurance industry waging a life or death struggle for their overpaid executives, over-compensated shareholders and politically connected supporters.
The “public option” is not “single-payer” but it may be a way-station on the track to single-payer. This is a politically palatable risk that probably should be taken.
But make no mistake about it, “Non-Profit Health Insurance Cooperatives” are nowhere near the tracks and are devoid of wheels even if they are forced onto the tracks. They would impede all traffic.
Consider that the Blue Crosses and Blue Shields are “non-profit” entities that exist as cooperatives, (consumers being the members of the co-op, contributing the co-op fee in the form of skyrocketing premiums). These fee amounts are not reflective of the needs of expenditures benefitting the co-op members nor are they regulated or controlled in any way to protect the investments being demanded of these members.
You see we already have “non-profit co-ops” in our Health Care delivery system and they are bankrupting Americans and their families. They are bankrupting American businesses and putting those businesses at such a global disadvantage that revitalization and stabilization of the United States economy is rapidly approaching the undoable stage.
The worst possible scenario is that false messaging and irresponsible alternatives cause a stagnation of real discourse and debate and we are left with the status-quo of guaranteed failure.
John Kowalko
When you Hippies can cut me a check for one hundred and fifty million we can talk. Until then, kiss my ass.
Would you want New Jersey running your health care? Sounds even worse to me. If you live in one of the corrupt states. The fact is the states already have this right and only 3 have chosen it.
John: Thanks for speaking up on this issue. If it does come down to the States…we would hope you would take it and run. Harris has sat on his ass for more 4 years. Why hasn’t the Senate done a score on single payer in Delaware…cuz they know when the facts are known and the savings understood anyone with l/2 a brain would throw the insurance companies out of this State.