With the rejection in the Senate Finance Committee of two separate proposals to create a substantial public health insurance option and, instead, the approval of the relatively weak co-op proposal (which the CBO estimates to be unlikely to establish a meaningful presence and will result in only half the budget amount of $6 billion will be spent) it seemed as though the public option had breathed its last breath.  However, new developments indicate that the public option, in various forms, is still alive. 

Senator Schumer (D-NY), having failed to pass his “level playing field” public health insurance option proposal in the Finance Committee, is pushing a new public health insurance option that would allow states to “opt out” of the public plan.  The opt-out proposal is gaining fans in the Democratic Caucus, even amongst conservative Democrats who are worried the effects a public plan could have on their state.   

Senator Carper (D-DE) meanwhile has been floating options that would allow states to “opt in” to a federal public insurance plan or for the states to create their own public options.  Under the second proposal, the federal government would provide seed funding. 

In the hope of gaining a “bipartisan” bill, Senator Snowe’s (R-ME) “trigger” public plan option is still being considered as well.   Under this option, a public plan would be introduced if the price of insurance did not decrease. 

Finally, although not discussed often, the fact remains that the Senate HELP bill being merged with the Senate Finance bill contains a nationwide public option for the uninsured and employers with less than 50 employees.  This option is somewhat weaker than the House Tri-Committee bill’s public option because its rates would not be based on Medicare and it would not require Medicare-participating physicians to participate in the new plan.

All of these options provide a menu of choices for those at the negotiating table merging the two bills in the Senate (Reid, Baucus, Dodd, Emanuel, and DeParle).  Estimates are that 52-54 Senators support some type of meaningful public option (more than the co-op proposal).  Supporters now seemingly include Sen. Evan Bayh (D-IN), who explicitly endorsed Senator Carper’s state “opt-in” proposal, a sign that even the most conservative Senate Democrats are at least open to the issue.  

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