The public option lives.
Senate Majority Leader Harry Reid (D-Nev.) announced Monday that the bill he will bring to the Senate floor will include a public health insurance option that individual states could decline to participate in.
"I've concluded --with the support of the White House, Senators Dodd and Baucus -- that the best way to move forward is to include a public option with the opt-out provision for states," said Reid, referring to the Senate health and finance committee representatives, respectively, Sen. Chris Dodd (D-Conn.) and Sen. Max Baucus (D-Mont.). "The public option, with an opt-out, is the one that's fair."
Reid has been pushing the so-called opt-out public option for the last several days and has spoken to nearly all 60 members of the Democratic caucus. He needs 60 votes to end an expected Republican filibuster and move the bill to the floor.
"We've spent countless hours over the last few days in consultation with senators who've shown a genuine desire to reform the health care system. And I believe there's a strong consensus to move forward in this direction," Reid said.
By including the public option in the bill before it goes to the floor, Reid is offering conservative Democrats a fig leaf of sorts. They can cast a vote in favor of ending a GOP filibuster -- when 60 votes are required -- but then vote against the public option later when the matter is debated on the floor, and only 50 votes are needed for victory. The move is also a gift to liberals, as the specific provision won't need to reach the traditional 60-vote threshold that is so often the death of genuine reform legislation.
Reid's move is a risky one, as a Senate Democratic leadership aide acknowledged Saturday to HuffPost. "The leadership understands that pushing for a public option is a somewhat risky strategy, but we may be within striking distance. A signal from the president could be enough to put us over the top," said the aide.
CNN reports that White House Press Secretary Robert Gibbs said in a written statement that President Obama is "pleased that the Senate has decided to include a public option for health coverage." CNN also reports: "An administration official went so far as to call Reid's move 'dangerous' but quickly followed by saying Reid knows his caucus better than anyone and will therefore have the support of the White House."
With high risk comes high reward, however. The public option's inclusion in the final bill would be one of the most significant progressive legislative achievements since the Great Society. The White House and centrist and conservative Democrats have been frustrated by liberals' strong demand for it, arguing that there is much more to health care than simply the public option and that only 10 to 12 million would be eligible to participate in it. Over the summer, Obama called it a mere "sliver" of reform.
Progressives, however, see the public option as the most realistic way to move the United States toward universal health care. Even those who are not eligible would benefit indirectly, they argue, as health insurance companies would be forced to reduce premiums to stay competitive.
The insurance industry sees the threat of the public option clearly. Karen Ignagni, President and CEO of the lobby group America's Health Insurance Plans (AHIP), blasted Reid's decision.
"A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality. The American people want health care reform that will reduce costs and this plan doesn't do that," she said in a statement. "The divisive debate about a government-run plan is a roadblock to reform. It's time we focus instead on broad-based reforms that will ensure the affordability and sustainability of our health care system."
But the public option is not just longed for by liberals. Recent polls have shown that roughly six in 10 Americans want a public plan that would compete with private insurance. Those polls were heard loudly in Congress. "All the national polls show a wide majority of Americans support the public option," Reid noted.
Reid appears to be within just a few votes of the 60 he needs. Putting the public option into the bill forces those holdouts to show their cards, and dares them to oppose their own leader on the party's most ambitious reform effort in nearly half a century.
Sen. Mary Landrieu (D-La.), a public option opponent, has said that while she disagrees with the policy in question, she isn't inclined to join Republicans in sinking the entire reform effort over it.
"I'm not right now inclined to support any filibuster," she told HuffPost last week. The refusal of the GOP to participate meaningfully in negotiations has soured her on joining them in a filibuster. "For the Republican Party to kind of step out of the game is very unfortunate," she said. "I'm not going to be joining people that don't want progress."
Sen. Ben Nelson (D-Neb.), another public option foe, wouldn't commit when asked last week. "I believe in playing chess, but that's about three moves ahead of me, and I'm not prepared to make those moves until I see some other moves in between," he told HuffPost.
Sen. Mark Pryor (D-Ark.), a conservative Democrat, sounded as if he could embrace Reid's strategy after meeting with the leader last week. "I'm open to a public option," he said.
Progressives oppose the opt-out provision that Reid intends to include to win conservative support, arguing that Americans in conservative states that may opt out are in just as much need of a public option as are residents of blue states.
Sen. Lamar Alexander, a Republican leader from Tennessee, said on the Senate floor Monday, in advance of Reid's announcement, that the opt-out provision isn't to be taken seriously. Medicaid, he noted, has an opt-out provision, but not one state has opted out. Public health insurance, in other words, is too popular for states to opt out.
At a meeting at the White House on Thursday evening, Reid told the president that he intended to push forward with the national public option with an opt-out provision. Obama, several sources said, indicated a preference for a "trigger" instead: the public option would only be brought into existence if the insurance industry failed to meet certain criteria in a certain period of time.
Yale professor Jacob Hacker, the intellectual father of the public option, however, dismissed the trigger.
"The trigger is an inside-the-beltway sleight of hand that would protect private insurers from the real competition that a strong public health insurance option would create," he said. "It is unworkable in the current Senate bills, unwise as public policy, and unwanted by the substantial majority of Americans who say they want a straight-up public option."