Health care issues: Public plan compromises

AP News
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Posted: Dec 15, 2009 10:50 AM

A look at key issues in the health care debate:

THE ISSUE: Are compromises being considered when it comes to letting the government sell insurance in competition with private industry?

THE POLITICS: The so-called public plan _ a new government insurance plan targeted at people who can't get affordable care elsewhere _ has been perhaps the most controversial element of the health care debate. Many Democrats say they'd like to see a plan like Medicare to give consumers affordable choices. Republicans and some moderate Democrats fear private companies wouldn't be able to compete. The search for a middle ground has been difficult.

WHAT IT MEANS: Any final health care legislation is unlikely to include the public plan favored by liberals. Under that version the government would pay providers rates modeled on Medicare, which hospitals and doctors say are too low, but which could yield the least costly premiums for consumers. The House started out with a Medicare-like approach but abandoned it in favor of a public plan that would negotiate payments with hospitals and doctors _ like private insurers do. In the Senate, opposition to a public plan appears insurmountable. It looks like the issue will have to be resolved in a House-Senate conference. A few compromises are possible. The latest version of the Senate bill calls for the federal agency that oversees coverage for members of Congress and federal government employees to offer the general public a range of private plans under its supervision. Sen. Olympia Snowe, R-Maine, favors holding a public plan in reserve and "triggering" it if private companies aren't providing enough affordable choices in any given state. Sen. Tom Carper, D-Del., has suggested leaving the decision to states, and giving them a menu of options from public coverage to their own employee health plans. Sen. Charles Schumer, D-N.Y., has suggested a federal plan that states can opt out of. Sen. Maria Cantwell, D-Wash., got an amendment included in the Senate Finance bill that would allow states to negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid, the government health care program for the poor.

_ Erica Werner