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Transcript: Health On The Hill – October 26, 2009

KHN’s Mary Agnes Carey and Eric Pianin talk about new optimism among liberal Democrats that a public option will be included in the final health overhaul bill. They also discuss Senate Majority Leader Harry Reid’s determination to have a bill soon. View the HOTH video or listen to the audio version (mp3).


JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill, a conversation about efforts to pass health care reform legislation. Joining me, Mary Agnes Carey of Kaiser Health News and Eric Pianin, also of Kaiser Health News. Welcome to you both. Over the weekend, it became apparent that the public option, the discussion of the public option has been revived. What happened?

MARY AGNES CAREY: It’s an amazing story. If you look back at the Town Hall meetings in August, a lot of opposition, loud opposition to the public plan. About a month ago, the Senate Finance Committee took a vote and did not vote for the public plan to be included in the Senate Finance Bill. At that point, a lot of analysts thought it was dead.

I think there has been a lot of pushback from progressive groups, from Democrats who have said now wait a minute, this debate is about choice and we want the public plan in there to provide choice to millions of Americans to help in the Democrats’ words and the words of President Obama “keep health insurers honest.” I think there was a very strong pushback and this is where we are now.

JACKIE JUDD: And what are the range of ideas now when we say the public plan, both in the House and the Senate?

MARY AGNES CAREY: There is debate over what the rates would be paid, for example, and the more robust option in the House had considered in the past was setting provider rates, what was paid to the doctors and physicians, tagging that to the Medicare reimbursement rates, or perhaps adding 5-percent additional for physicians.

There seems to be more support coalescing behind a public plan where the rates are negotiated, so it means you wouldn’t save as much money, but it may be more political acceptable to folks, and now there is a discussion about putting the public plan into the Bill, letting states opt out if they choose.

JACKIE JUDD: And what does the White House think of all this discussion?

ERIC PIANIN: Well, I think the White House is very excited that the prospects of improved or passage of health care reform this fall. The President desperately wants to have a Bill on his desk. I think that there still is some real tension between the White House and Congressional Leaders over the best approach and what form of public option would be most saleable and politically wise.

JACKIE JUDD: What signals did you pick up on over the weekend about what the White House would like the public option to look like at this moment?

ERIC PIANIN: I think the President and his advisors want what many people think is a relatively weak version of the public option. They don’t want the public option to take effect immediately. Instead, they want to see how the legislation works out.

If, down the road in certain states, citizens are not afforded adequate insurance at reasonable prices, if in some states 95-percent of the citizens do not have the option of getting affordable insurance, then this public option would trigger in. And I think that there is a feeling on the Hill, particularly among liberal Democrats including Harry Reid the Senate Majority Leader that is too weak a version.

What they would prefer is what Mary Agnes was discussing, this provision where you create a public option, if states want to opt out of it they may, but for the rest of the country there would be a public option.

JACKIE JUDD: And what is the political calculation that the White House would at this moment support? What is the most cautious approach to a public option?

ERIC PIANIN: Well, I think that the President at this point would prefer the trigger mechanism and I think part of it is a concern that many conservative Democrats who have to run for reelection next year would have a very tough time defending a robust public option. They want the weakest version, if you will, and the trigger mechanism certainly fills that Bill.

JACKIE JUDD: Okay and on Capitol Hill, Senator Reid, the Senate Majority Leader, is trying to cobble together a single Bill from the two committee Bills. What is the status of that?

MARY AGNES CAREY: The negotiations are ongoing with members of the Senate Health, Education, Labor and Pensions Committee as well as the Finance Committee. We have had White House representatives in the room. They are hoping to finalize the discussions this week, get a Bill to the Congressional Budget Office, also known as the CBO, to give a score to see if it will hit that $900 billion mark that the President has set and if it doesn’t they would have to make adjustments but they want to see what the price tag is because they have told members that they want to do that before the Bill goes to the floor.

JACKIE JUDD: But we don’t know the contours of it yet.

MARY AGNES CAREY: We don’t know yet. Of course, they are negotiating; for example, the Bills differ on things like would there be an employer mandate? It is in the HELP Committee Bill, not in the Senate Finance Bill. How would the individual mandate work? The HELP Committee Bill has a very robust public option. The Senate Finance Bill has this co-op provision that had been inserted, so we have to see how they work out those differences.

JACKIE JUDD: Okay, thank you to both, and thank you for joining us. I’m Jackie Judd.

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