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Medicare Buy-In Emerges as Sweetener to Woo Disappointed Liberals

By John Reichard, CQ HealthBeat Editor

December 7, 2009 -- Democratic senators and staff members reassembled late Monday to take another crack at reaching an agreement on language pertaining the "public option," the controversial provision in the Senate health care overhaul bill (HR 3590) complicating efforts by Democrats to attract the 60 votes they need to pass the proposal.

A meeting Sunday evening between moderate and liberal Democrats divided on the issue failed to produce a compromise, but New York Sen. Charles E. Schumer reported "a great deal" of progress on the issue. However, Nebraska's Ben Nelson, a strong critic of the public option, gently hinted that Schumer was engaged in spin, describing "my good friend" as "optimistic."

Schumer said, however, that staffs of the senators would meet later Sunday evening and on Monday. One new element apparently on the table is discussion of a "Medicare buy-in," which presumably would allow the uninsured to pay premiums to enter the popular government insurance program for the elderly and disabled.

Details of the proposal weren't immediately available. Another proposal that has surfaced would involve creating an additional option in insurance exchanges giving small businesses access to national nonprofit plans. The nonprofit options apparently would be negotiated by the Office of Personnel Management (OPM), which runs the Federal Employees Health Benefits Program. That program is often cited by centrists and conservatives as an example of how to use marketplace forces to restrain premium increases.

The OPM model likely wouldn't satisfy liberals hungry for a new government-run insurance plan as distinct from an added selection of private plans negotiated by government officials. But a Medicare buy-in might ease the sting.

Sen. John D. Rockefeller IV, D-W.Va., said Thursday afternoon that a Medicare buy-in "is popular with me, but it wasn't with Kent Conrad or Max Baucus," referring to the chairmen of the Senate Budget and Senate Finance committees, respectively. It wasn't clear, however, the context in which Rockefeller was referring to a Medicare buy-in.

Another alternative to a robust public option would entail tough regulations to ensure more affordable private coverage. Rockefeller briefly showed reporters a document that included such regulations, including one that would require insurers to pay out 90 cents of every premium dollar for health care. Urging reporters to look at the list, Rockefeller said, "See all those round circles? Those are things that have sort of been agreed to by Ben Nelson—sort of, maybe." Rockefeller then seemed to backtrack a bit to say that Nelson was at least willing to look at them—"considering, considering, considering," Rockefeller amended.

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