Senate Looks for Possible Compromises on Public Option

Janice Simmons, for HealthLeaders Media , December 11, 2009

On the 11th day of Senate floor debate on healthcare reform, Majority Leader Harry Reid (D-NV) slowed down the pace—reserving the afternoon to address appropriations legislation and cancelling plans to work around the weekend like the week before. Ironically, the most disappointed in this slowdown were the Republicans.

"We were in last weekend presumably because the majority felt it was really important to try to pass this healthcare bill. We agree it's an important subject, and we'd like to vote," said Senate Minority Leader Mitch McConnell (R-KY) at a briefing.

Overall, Thursday failed to bring a clearer picture of the exact plan that the Democrats have in mind—whether the public option is being dropped completely or whether some new proposals are gaining acceptance among most of the senators. Each decision will have supporters and detractors not only within the Senate, but outside the walls of the Capitol, which the legislators will have to take into consideration.

Now under review, a provision making Medicare accessible to the estimated 4.5 million uninsured Americans between the ages of 55 and 64. While not new, the idea (which emerged even before the Clinton era) is seen as gaining acceptance among those who would like to see movement toward a single-payer system.

However, this system has made major providers of care—including hospitals and physicians—uneasy after previously pledging to cut down on care costs during the next decade. At particular issue are the lower reimbursement rates paid under Medicare when compared with private insurers. More details are pending until a cost estimate is issued from the Congressional Budget Office—probably by early next week.

Also under consideration is creation of a plan—such as the Federal Employee Health Benefit (FEHB) plan—which supports health coverage for nearly 8 million government employees and their families.

The Office of Personnel Management operates FEHB as a huge employer sponsored health plan, with the federal government picking up a share of the premiums. Federal employees get the opportunity to work with regional and rate based plans offered through the FEHB.

The OPM could bring its ongoing experience in negotiating contracts with insurers to provide health coverage on a state and regional basis. However, it is unclear whether the office is prepared to take on a huge new program.

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