Conrad Inching Towards Acceptance Of The Public Option

Throughout this health care reform legislative process, I have been very critical of the part Sen. Kent Conrad has played in health care reform. I've been especially critical of his co-ops idea and his opposition to the public option. But since the House agreed to decouple the public option from Medicare rates, Conrad has expressed some tepid openness to the public plan. The MinnPost reports:

The Senate bill that Majority Leader Harry Reid, D-Nev., plans to bring to the floor next week includes a cooperative model "and leaves open the possibility of public option that is not tied to Medicare reimbursement rates," Conrad said.

"So I think you can begin to see the outlines of a compromise," Conrad said. "I think public option will be included as an alternative (in the final bill), but not tied to Medicare levels of reimbursement. And there will be a not-for-profit alternative, and that will be a cooperative model."

Not what you would call ringing endorsement of the public option, but Conrad does not sound like a man who is about to threaten to bring the whole bill down if it includes one. In fact, it sounds like Conrad might be willing to vote for a final bill that preserves a public option. If that is the case, this is as much as progressives could hope for or should expect from this North Dakota Democrat.

Ironically, Conrad could be instrumental in the eventual successful implementation of the public option. He made sure the Senate Finance Committee included an additional reinsurance program for the individual market. It would be in place for the first few years after reform started. This should help, at least temporarily, to alleviate the problems associated with the insufficient risk adjustment mechanisms in the House bill.

Both the CBO and CMS concluded the weak risk adjustment mechanism in the House bill would force the public option to charge higher premiums, because of adverse selection. It would get more expensive, less healthy customers than the private insurance plans, which have worked to avoid them. Conrad added the reinsurance program to help protect his fledgling co-ops from being turned into a dumping ground for less healthy customers by the private insurance companies. But the reinsurance program will be of equal benefit to the public option, potentially protecting it from a similar fate. This reinsurance program might just be instrumental in getting the public option succesfully up and running. I would have never written this a few months ago, but it looks like Conrad might no longer be one of the biggest obstacles for the public option. Of course, senators are fickle creatures, and the public option Conrad is talking about might not be a real public option at all if it is anything like Carper's "Plan B."