Drive for Robust Public Option in Health Care Reform Legislation May Be Waning

By Staff Report

Oct. 26, 2009

The battle cry among House Democratic leaders for a robust public option health care plan based on paying providers Medicare rates plus 5 percent 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-California, 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 during 10 years, Pelosi said at a news conference. She added 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” during a 10-year period, offering a 50 percent discount on brand-name drugs as the gap in the doughnut hole gradually disappears.

Other reimbursement formats for the public option have been under consideration, such as one establishing negotiated rates with a Medicare-plus-5 percent “trigger” kicking in if premiums rise 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-South Carolina, told reporters.

Filed by Jennifer Lubell of Modern Healthcare, a sister publication of Workforce Management. To comment, e-mail

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