Boswell still supports a public option for health care

by: desmoinesdem

Tue Jun 09, 2009 at 15:04:35 PM CDT

Background and details are after the jump.

Republican opponents of serious reform are mostly trying to keep the public option out of the health care bill, dangling the carrot of substantial bipartisan support. Some corporate-friendly Democrats are trying to destroy the public option by either making it uncompetitive with private insurance or stipulating that the public option could only be "triggered" if private insurers fail to meet certain benchmarks within several years (by which time, Barack Obama might conveniently no longer be president).

Howard Dean has been deriding the "trigger" proposal as a "fake public option" that would be set up to fail. Tim Foley explains why:

All of these terms - "meaningful," "affordable" and "several years" - are as vague as can be. The trigger may be set up so, in effect, it never happens, similar to the Medicare Part D trigger that would have created a public prescription drug plan - but never did.  The threshold would be low enough that it could be easily, and superficially, met.  Throughout those "several years," the insurance plans would receive all of the uninsured who enroll through a National Health Exchange, pocketing what we can hope are generous government subsidies, with very few changes to their behavior. And even if the trigger is met and a public plan created years down the road, private insurance would have serious "status quo bias" on its side.

The editorial board of the Des Moines Register strongly supports the public option, and so do most Iowans:

A recent Des Moines Register Iowa Poll found 56 percent of Iowans favored creation of a public health-insurance plan, 37 percent opposed it and 7 percent were unsure. The poll of 802 Iowans was conducted March 30 through April 1.
Nearly 50 percent of those who weren't already covered through a government plan (Medicare or Medicaid) said they would "definitely enroll" or "look seriously at enrolling."

There has been some confusion in recent days over Congressman Leonard Boswell's stance on the public option. Earlier this year, Boswell signed on with Health Care for America Now's core principles on health care reform. When the Des Moines Register surveyed Iowa's representatives in Congress last week, Boswell answered that he supported a public option. (I was unable to find a link to the survey answers on the Register's website.)

But late last week, the House Blue Dog caucus issued their own statement on health care principles, signed by the 15 members of the Blue Dogs' Health Care Task Force. That document (pdf file) contains some ominous language:

The Blue Dog Coalition strongly supports health care reform that lowers costs for families and  small businesses, increases choice and competition, and allows individuals to keep their doctor.  We are concerned, however, about a "Medicare-like" public option and its ability to achieve all  of the benefits put forth by its proponents. How a public option is constructed and allowed to  compete are critically important to ensuring families have the ability to keep their current health  coverage and continue to see the doctor of their choice.  

While the Blue Dog membership has not endorsed a public option, we feel that should a public  option be included in comprehensive health reform, it should adhere to the following conditions  at a minimum:
   •  Adheres to the Free Market: Medicare payment rates, which include structural payment  inequities involving lower reimbursement to rural areas, must not be used as the basis for  reimbursement. Rather, rates must be negotiated between the plan and its providers as is  the case currently for all health insurance plans.  [...]
    •Available Only as a Fallback: The availability of a public option would occur only as a fallback and in the absence of adequate competition and cost containment. Fundamental  insurance market reforms and increased choice through the Exchange should improve  access and contribute to lower costs. However, should the private plans fail to meet  specific availability and cost targets, a public option would be triggered and be allowed to  compete on a level playing field subject to the conditions outlined above.  

Boswell isn't on the Blue Dogs' Health Care Task Force, so it was unclear whether he agreed with all the conditions they want to attach to a public option.  He has received $304,680 from the health care industry, according to "data from the Center for Responsive Politics" compiled by the Huffington Post.

As Ryan Grim of the Huffington Post reported,

20 members of the [Blue Dog] coalition had previously signed a pledge expressing their support for a public option without a trigger. The statement was written and organized by the reform coalition Health Care for America Now (HCAN), which strongly opposes a trigger and sees it as an industry plot to strangle a public option in the crib.

Blue Dogs, by their charter, need two-thirds of their 51-member caucus to approve a position before it can be officially adopted. With 20 Blue Dogs backing a public option, they would be short several votes if everyone stuck to their pledge in the closed-door meeting.

I sought clarification from Boswell's current spokesman, Mark Daley, and received this statement via e-mail:

He does support a public option and believes that it is essential if we are going to bring costs down and improve care. However, we need to be careful in crafting a system and not perpetuate many of the flaws in payment that Medicare delivers. Providers in Iowa provide some of the most efficient and high-quality care for their patients, yet they are consistently dead last in Medicare reimbursements. Essentially, Iowa providers are penalized for efficiency. Boswell introduced H.R. 362 to help certain hospitals stuck at the bottom of the food chain and continues to fight for fair reimbursements.

The Congressman supports expanding coverage and making all Americans stakeholders, but the public option has to be pragmatic and ensure that people who like the coverage they currently have get to keep it and that they are allowed to continue seeing their family doctors. He also supports the Presidents goal of keeping it deficit neutral.

As for the Blue Dog's release (which I've attached) it is not an endorsement of a public option, rather a statement of things they would like to see included in a public option. It echoes much of what I mentioned above from the congressman's perspective - it should not penalize efficient providers like those in Iowa, it should protect a person's right to see the doctor of their choice, and if you currently have coverage that you are happy with, you can keep it.

Boswell makes a valid point about Medicare reimbursement rates, but this statement didn't answer all of my questions, so I contacted Daley again for a specific answer regarding a "trigger" for the public option, and received the following reply:

The trigger would come into play when private insurance providers fail to make healthcare affordable and accessible to everyone.  Given there are 40 million plus uninsured today, that criteria is certainly met.  Congressman Boswell thinks a public option is essential to meeting the healthcare needs of America.

Just to make sure I wasn't missing any clues to wiggle room on this issue, I wrote back:

If I understand you, then Congressman Boswell still favors a health care reform bill containing a public option that went into effect immediately.

In other words, he does not fully agree with the letter the Blue Dogs issued late last week, saying the caucus would only support a public option if the bill contained a "trigger" provision delaying the availability of the public option for several years.

Have I understood Boswell's position correctly?

To which Daley replied,

You are correct in your understanding of the congressman's position.

So, all Democrats representing Iowa in Congress are committed to the public option. Let's hope that Senator Tom Harkin was correct when he told an audience in North Liberty on June 6, "we are going to have a public option plan."

UPDATE: Grim reports at Huffington Post that Congressman Jim Cooper, the vice chairman of the Blue Dog Health Care Task Force, says he supports a public option with no trigger.