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Although, in theory, a House/Senate conference committee could insert a rigorous public option in the reconciliation process, if the current trend in Washington prevails, the health care reform bill that emerges from the committee will not have a national public option; nor will the Obama administration require one, the AP reported.
It could, however, offer states the opportunity to "opt-in" to a public option, or contain a "trigger" -- some level at which a national, public insurance program would take effect, if, for example, a certain percentage of a state's residents remains without health insurance after a specified year, say 2012 or 2014. The former would both enable states with existing, successful universal health care programs to continue them. It would also allow states -- provided they are meeting federally-set goals for universal coverage -- to participate in the federal program on an as-desired basis.
Also, look for congressional Republicans -- and selected congressional Democrats -- to continue to lobby for the right for citizens to not buy health insurance if they don't want it. Conversely, The Obama administration and most congressional Democrats will continue to push for mandatory insurance for all, with subsidies to help the poor/working poor pay for premiums: getting everyone into the system (and out of the untenable emergency room primary care habit) and attaining an adequate pool of subscribers to lower per person insurance premium costs over time, are dependent on a mandatory insurance law.
Fiscal Analysis: The opt-in or trigger format may prove to be the clincher that enables not only health care reform, but some sense of national harmony on the issue. Or, as a colleague in public policy frequently remarks, "The states are great laboratories!" For example, Congress may end up establishing two, federal opt-in insurance programs for the states, each with three coverage levels (minimum, better, best).
States that don't have universal health care programs and that fall below federally-set, universal coverage targets, would then be given a choice of public insurance plans: a modest-cost plan for states with modest resources or a more-generous plan for states with an increased ability-to-pay.
Financial Editor Joseph Lazzaro is writing a book on the U.S. presidency and the U.S. economy.
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