Reid's end game? Senate bill will have public option with 'opt out'

Senate Majority Leader Harry Reid announced yesterday that he will include a public insurance plan in the final Senate health overhaul legislation. 

The Washington Post: "Reid's decision was a reversal from two weeks ago, when the Nevada Democrat appeared inclined to set aside the idea -- among the most divisive in the reform debate -- in an attempt to avoid alienating party moderates." It remains to be seen if Reid has the votes to pass the bill in the Senate with the public option.

"The Senate provision would give states the right to opt out of a government plan, though Reid spokesman Jim Manley was unable to provide further details, describing the legislative language as a work in progress that has yet to be scrutinized by the Congressional Budget Office." The inclusion of the public option will likely mean Sen. Olympia Snowe, R-Maine, who voted with Democrats during the Finance Committee's consideration of a reform plan, will not support the bill, The Post reports. She prefers a "trigger" option that would allow a public option only if insurers fail to rein in costs (Murray and Montgomery, 10/27).

The Los Angeles Times: "The opt-out provision falls short of liberals' hope for unconditional approval of a public plan, but it comes closer than the co-op or trigger mechanisms. For one thing, it would be national in scope and could be activated immediately. Also, by requiring states to take legislative action to exit the plan, it increases the burden for opponents" (Levey, 10/27).

The New York Times calls the opt-out provision an "escape hatch." Aides said Reid is short of the 60 votes needed to block a filibuster on the bill. "Mr. Reid's decision was acclaimed by liberal organizations like MoveOn, Families USA and Health Care for America Now, a coalition that includes labor unions and civil rights groups." The option would be available starting in 2013, Reid's aides said, and would negotiate payment rates with doctors, hospitals and other health care providers. "Some liberal Democrats ... have said payments should be pegged to Medicare rates, which could save money for the government and for consumers" (Pear and Herszenhorn, 10/26).

NPR calls the move Reid's "big health care gamble." "Inserting a public option into the Senate bill obviously greatly increases the chances that a government-run option will emerge after House and Senate Democrats meet to merge their competing health care bills. … By including the provision in the bill instead of offering it later as an amendment from the floor, Reid guaranteed that it would require 60 votes to remove the public option provision from the legislation" (Halloran, 10/26). 

The Associated Press: "The reaction from moderate Democrats — they fear a public plan could drive insurers out of business and take over the marketplace — ranged from muted to skeptical. … If Snowe doesn't come back, the fate of Reid's public option could rest in the hands of a few key moderate Democrats including Sens. Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana" (Werner, 10/27).

Politico: "It is difficult for Reid to game out the vote count that far because of the unpredictability of the floor debate. But it is precisely what's giving some Democrats pause" (Budoff Brown, 10/26).

The Christian Science Monitor: "Sen. Tom Harkin (D) of Iowa, chairman of the Senate Health committee, has said that there are 52 firm votes in favor of the public option in the Democratic caucus and five or so opposed" (Grier, 10/26).

The Boston Globe reports on more specifics, though sparse, on the plan: "Reid would not say who - governors, state legislators, or voters - would decide whether a state would opt out. It was also not clear how long each state would be in the program initially. Reid said states could begin opting out in 2014, a year after aides said the public option would begin operating, but aides would not answer detailed questions" (Milligan and Wangsness, 10/27).

Roll Call reports that Democrats are seemingly satisfied going it alone on the bill and that the Congressional Budget Office will now give a cost estimate (Drucker, 10/27).

CongressDaily reports that Reid didn't ask for a score on Snowe's "trigger" proposal or an opt-in proposal pushed by Nelson. "Republican senators and aides argued Reid will not find the votes for cloture on the opt-out bill, but is laying the groundwork to quickly bring up a weaker bill designed to attract others if the cloture vote fails" (Edney, 10/27).

Finally, The Wall Street Journal has a primer on how the government-run public plan would work with a Q&A (Adamy, 10/27).