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member of the Finance committee

Can States Do the Public Option?

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The latest wrinkle in the public option debate (via Politico initially) is a proposal that comes from Senator Tom Carper, the Delaware Democrat that sits on the Finance committee. According to the proposal's latest draft, which Carper's staff is circulating but--I'm told--Carper himself is not really hawking yet, the idea is to let states set up their own alternative coverage options. Those options include starting a non-profit co-operative, opening up the benefits plan for state employees, or, yes, starting a real public plan.

There's no trigger, at least in the document I've seen. All it would take would be action by a state legislature, signed by that state's governor. And states would be free to join with other states and create joint plans.

But there would be various restrictions: A state couldn't create a public plan that tied reimbursements to federal Medicare rates (even with a higher percentage added on) and they couldn't compel providers to participate. In these respects, states would be free to create relatively weak public plans--like the compromise measure Senator Charles Schumer has proposed--but not relatively strong ones--like the version Senator Jay Rockefeller has put forward.

One interesting question is whether the proposal is already redundant, thanks to an amendment that another member of the Finance committee, Ron Wyden, introduced that Chairman Max Baucus accepted before the hearings even began.

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