The Power of A

In a move the national media is decrying as the death of the public option, the Senate Finance Committee voted down two amendments yesterday that would have inserted language into the Chairman’s Mark creating and funding a public insurance plan run by the federal government.

The Chairman’s Mark currently has language funding the creation of nonprofit cooperative health care plans, an idea meant to entice Republican and moderate Democratic votes for the Finance Committee legislation.  Both amendments sought to replace the cooperative language with public option language.  The first amendment, offered by Senator Rockefeller (D-WV), would have created a public option with a reimbursement structure for the first two years that mirrored Medicare, after which the government would have negotiated reimbursement rates with providers.  The proposal, seen as the most liberal public option plan, was defeated 15-8 with opponents claiming the Medicare rates were too low for doctors and hospitals.

The second amendment was offered by Senator Charles Schumer (D-NY).  Like the Rockefeller amendment, the Schumer amendment would have created a public plan but have negotiated reimbursement rates with providers from its creation.  That amendment was defeated by a 13-10 vote, with all 10 Republican committee members voting against it with Senators Lincoln (D-AR), Conrad (D-ND), and Baucus (D-MT).  After considering those two amendments, the committee moved through a few more amendments (including approving a Republican amendment requiring members and staff to participate in a state-based exchange for insurance) before adjourning around 10 PM.  The markup will continue at 10 AM today, and is being broadcast over the internet at the committee website.

The 10^th Annual Summit Awards Dinner

A special thanks to those who attended and supported the 10^th Annual Summit Awards Dinner last night at the National Building Museum.  The dinner honors six incredible association programs (which you can see here) that exemplify the Power of A message of associations as pioneers of collaborative problem solving.  Please visit our site www.asaecenter.org/summitdinner in the upcoming weeks to view pictures of the event and find out more information about next year’s dinner.

Quick Hits

Roll Call (subscription) is reporting this morning that the White House is preparing a draft (or possibly multiple drafts) of health care legislation that can be introduced or use to influence the debate if Congress stalls on consideration of comprehensive legislation… America’s Health Insurance Plans, the trade association for the insurance industry, released an outline of how the Finance language would affect the insurance industry… Senator Carper (D-DE) is discussing with Democratic senators a state-based alternative to co-ops and the public plan… House leadership tries to trim the cost (subscription) of the Tri-Committee bill back to $900 billion.

Although it has been hinted at for weeks, this Sunday the Obama administration made its biggest hedge of support for the “public plan”.  On CNN’s State of the Union Sunday night, Department of Health and Human Services Secretary Kathleen Sebelius said the public plan “is not the essential element” to health care reform for the administration.  She also signaled potential support for the co-ops plan being considered in the Senate Finance Committee.

Sebelius reiterated on the program that the essential components for any health care plan that would be supported by the White House are choice and competition.  Her remarks came one day after the President at a town hall in Montana called the public plan “one sliver” of overall health care reform.

Update: White House and Congressional officials clarified Secretary Sebelius’ comments, saying that the administration still supports the public plan but does not consider it the most important part of reform.

The Senator who initially proposed the co-op proposal, Senator Kent Conrad (D-ND), said on Fox News Sunday that the public plan did not have enough support in the Senate, and his co-op proposal was the only plan that could attract enough votes to pass comprehensive health care reform.  He also reiterated that the co-ops that would be established would be nonprofit and member-run.  On the same program, Senator Richard Shelby (R-AL) expressed tentative support for the co-op proposal, lending credence to the idea that co-ops can be a bipartisan proposal.  You can read more details on the co-op proposal here.

The problem with the co-op proposal from a political standpoint comes from some members of the Democratic caucus.  Last month, members of the Progressive Caucus sent a letter to the House leadership stating that the letter’s 60 signatories would not support any comprehensive health care bill without a public option.  Yesterday, Rep. Eddie Bernice Johnson (D-TX) told CNN that a public plan was an essential element for liberal support for a bill.  “The only way we can be sure that very low-income people and persons who work for companies that don’t offer insurance have access to it, is through an option that would give the private insurance companies a little competition,” she said.

Quick Hits

Politico reports that a revised timeline for House passage of health care has been released.  Merging of the three committee bills is about 80-85% done, and the new target date for passage is the end of September… The Senate is still looking to hold to the September 15 deadline for a Finance Committee deal, and a possible deadline for floor passage would be right before Columbus Day… Is the administration’s promise that a new plan would allow everyone to keep their insurance accurate? asks The Washington Post.

Key Senators negotiating aspects of the Finance Committee health care reform bill spoke to the media yesterday and gave further details on the still-unfinished legislation.  Senator Kent Conrad (D-ND) gave further details on the bill’s “co-op” proposal, and although the media coverage focused mainly on the debate among Democrats (subscription) on whether a co-op could substitute for the public plan, the details sound similar to an idea that associations have been supporting as needed reform for years.

According to Congress Daily (subscription), Conrad said co-ops could be established at the local, state and national level.  States could establish the local co-ops, but Conrad failed to elaborate on what entities could establish national co-ops.  These co-ops would require $6 billion in start-up costs, but Senate negotiators are estimating that a series of co-ops would provide insurance to 12 million Americans, which would make it the country’s third largest insurer.  Policies and regulations would initially be established by the Department of Health and Human Services.

The idea of local co-ops is not a new one to associations; as noted in this space yesterday associations such as the National Cooperative Business Association and National Rural Electric Cooperative Association provide structure for co-ops in their specific areas.  The Los Angeles Times also provides more details on existing co-ops in this article.  But in the health arena the concept of pooling for health insurance has long been a reform supported by associations.  In the current Congress, numerous associations have supported and pushed the Small Business CHOICE Act (HR 859), sponsored by Reps. Nydia Velazquez (D-NY) and Sam Graves (R-MO).  The legislation would allow small businesses that belong to the same association to pool in the catastrophic insurance market and create a reinsurance backstop that provides coverage when the small business’s primary care coverage is exceeded.  Prior to this, many association supported association health plan (AHP) legislation, which would have allowed associations and small businesses to create national insurance pools to make insurance affordable for members and members’ employees.

Based on the information released, do you think a series of local and national co-ops for health insurance would achieve the same as a series of AHPs?

Quick Hits

House Small Business Chair Velazquez pens a letter to Energy & Commerce Committee Chair Waxman (D-CA) advocating for changes in health care bill to help small business, including HR 859… President Obama visits AARP to hold a health care discussion… the latest White House push on health care… House Democrats still trying to decide how to proceed with their health care bill.