Drive for robust public option appears waning

The battle cry among House Democratic leaders for a robust public option health plan based on paying providers Medicare rates plus 5% appears to be weakening.

Responding to news reports that she did not have enough votes in the House to support a robust public option, House Speaker Nancy Pelosi (D-Calif.) acknowledged that this proposal “was not the only way” to craft a public plan, and that a final decision on a public option and a final vote count had yet to be reached.

It's clear, however, that in reviewing potential formats for a public plan, the robust option saves the most money, $110 billion over 10 years, Pelosi said at a news conference, adding that “at the end of the day we will have a public option” in the House health reform bill to keep costs down and keep insurance companies honest.

Pelosi also announced several changes to Medicare benefits under the bill, including a pledge to eliminate the program's so-called coverage gap or “doughnut hole” over a 10-year period, offering a 50% discount to brand name drugs as the gap in the doughnut hole gradually disappeared.

Other reimbursement formats for the public option have been under consideration, such as one establishing negotiated rates with a Medicare-plus-5% “trigger” kicking in if premiums rose too quickly, or one pairing negotiated rates with an expansion of Medicaid.

Whether the House would consider a Senate proposal to allow states to “opt out” of a public plan is something that would have to be worked out in conference with the Senate, House Majority Whip James Clyburn (D-S.C.) told reporters.

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