It looks like the White House's endgame may very well include a public option trigger, as a means of bringing Olympia Snowe and other key centrists on board. In fact, Obama met with Snowe today to talk about the bill, so there's no question that her ideas and concerns are being taken quite seriously. But what would a Snowe-endorsed trigger actually look like? Today, I spoke with some sources close to the debate and got a clearer picture of the kind of fall-back plan she'd be inclined to support:
First, the government would establish a standard of "affordability" --yet to be determined--that would gauge whether Americans had access to reasonably priced health insurance, based on their income, family size, employer-backed benefits, subsidies, and so forth. Then, on a state-by-state basis, the government would test to see whether enough people--about 95 percent--had access to affordable coverage according to this standard. And if the private reforms alone weren't enough in a given state, a government-backed "safety net option" (as Snowe prefers to call it) would be introduced into the state's health insurance exchange. The fall-back option--which would essentially be the same government plan wherever it was implemented--would be run by a non-profit organization that would serve as a kind of a hammer over private industry to make sure it will perform.
Notably, Snowe wants the government to make this determination as far as a year before the insurance reforms actually go into effect (around 2013 in the Baucus plan/HELP bill). The idea is that private insurance companies would have to release their pricing and bids well in advance, so we wouldn't have to wait and see if the system fails to make coverage affordable. This appears to be the thinking behind Snowe's recent comments that she'd "support a public plan which is available from day one--in any state where private plans fail to ensure guaranteed affordable coverage."
So how far would a trigger go towards achieving liberal goals? Would it necessarily mean surrender? A lot depends on that "standard of affordability"--specifically, whether it is actually a rigorous measure that would accurately determine whether Americans had access to affordable coverage. Also critical is that the government-run plan itself should be viable, should it be "triggered." In either case, it will take a strong political constituency to win such terms in the reform bill. And, as Ezra points out, the constituency for creating such a substantive compromise may be hard to find, particularly as liberals are already lashing out against the trigger alternative.