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WASHINGTON — Let the states deal with it.
That's the latest idea on Capitol Hill as Senate Democrats seek a compromise on one of the most controversial areas of the health care debate — whether to offer a new government health insurance plan.
Backers of a state-based approach hope it could garner support from liberal Democrats who are committed to a new national plan and conservative Democrats, including Sen. Ben Nelson of Nebraska, who have balked at such government plans.
Nelson said Tuesday that a state-based approach seems to have some momentum.
“It all depends on the details, but I think there's a legitimate argument for giving the states an option for solving this problem,” Nelson said.
He noted that states already have experience with public plans such as S-CHIP, which is aimed at covering children of the working poor.
Nelson said the federal government still would need to provide adequate resources so any state-based program does not turn into an unfunded mandate, but he said the idea has a lot of merit.
“As a Jeffersonian Democrat, someone who believes that the laboratories of democracy typically work, I think it makes good sense for this type of approach,” Nelson said.
Supporters of a new government plan, often called the public option, say it would exert some control over health care costs by providing much-needed competition to the private insurance companies.
Critics say such a national plan nothing more than an expensive, heavy-handed government takeover of health care.
One benefit to leaving the creation of new public plans up to the states is that if one state makes mistakes in crafting its plan, the damage would be limited, Nelson said.
The Senate Finance Committee, set to vote soon on its version of the health care bill, already rejected two different versions of a public option.
But the panel approved a state-based approach for providing access to health coverage to people earning up to twice the federal poverty level, or about $44,000 for a family of four, who don't receive insurance through their employers.
That proposal, offered by Sen. Maria Cantwell, D-Wash., redirects federal funding included in the legislation from individual subsidies and instead gives that money to the states.
It is then up to the states to negotiate with private insurers to get the best price for covering those eligible.
Sen. Tom Carper, D-Del., talked about other state-centric ideas, such as creating regional exchanges or having states open up their employee benefit programs.
At some point the Finance Committee's legislation will have to be blended with the bills already approved by other congressional committees that include a more traditional public option.
The state-based proposals could be the basis for that blending. Whatever emerges will be closely scrutinized by all sides.
Nebraska Appleseed has advocated a strong public option.
Jennifer Carter, director of the group's Health Care Access Program, said a state-focused approach might work.
“As long as it's actually something that has some power to truly negotiate for people in a way that will make their coverage more affordable and make sure that we're holding the insurance companies accountable,” Carter said.
Sen. Mike Johanns, R-Neb., who has criticized a national public option, was skeptical, however.
He said it's hard to judge the state-based proposals without more concrete details, but he said the health plan model used in the state of Washington has run into significant cost problems.
“I haven't seen anything yet that makes me like it better than a national government ... program,” Johanns said.
Contact the writer:
202-662-7270, joe.morton@owh.com
