WASHINGTON – The unexpected new proposal forged by the Senate for breaking the impasse over creation of a government-run medical insurance plan won President Barack Obama’s endorsement Wednesday and raised hopes among many Democrats that the way may be clearing to pass their massive health care bill by Christmas.
The deal, which emerged late Tuesday night after days of secret negotiations, would eliminate the government-run insurance program many liberals see as the linchpin of real reform and some moderate Democrats see as a deal-breaker.
But paradoxically, the heart of the compromise may be a more durable, if initially smaller, form of the public option – an expansion of Medicare, the huge and hugely popular federal health insurance program for seniors.
By enlarging Medicare eligibility to Americans between 55 and 64, the compromise may also sharply expand the base of political support – giving Americans a concrete stake in what at times has seemed to be a distant battle over arcane proposals.
Under the deal hammered out by 10 Democratic negotiators, potentially millions of Americans could sign up for a program that has been embraced by both parties as a vital safety net for the country’s retirees.
That prospect has excited some proponents of creating a single-payer system who saw even the weak government program in the original bill as little more than a “camel’s nose under the tent.”
“Expanding Medicare is an unvarnished, complete victory for people like me,” said one such liberal, Rep. Anthony Wiener, D-N.Y. “It’s the mother of all public options. We’ve taken something people know and expanded it. … Never mind the camel’s nose, we’ve got his head and neck under the tent.”
Even Rep. Lynn Woolsey, D-Calif., a leader of the House Progressive Caucus, was cautiously optimistic, dropping her earlier insistence that the bill include the so-called “public option” – a new government-run plan to compete with private insurers.
“It doesn’t have to be a public option,” Woolsey said. What matters is that the health care bill increase competition, affordability and the number of people who are insured, she said.
Despite the enthusiasm, the proposal must clear at least one big hurdle: cost. The nonpartisan Congressional Budget Office has not yet analyzed the idea, and its conclusions could be a major factor – whether positive or negative – in determining whether the compromise opens the way for final Senate action on health care.
Still, the idea – which had been discussed earlier this year but fell by the wayside – opened up some potentially game-changing possibilities.
Todd Swim, a partner with the health benefits consulting company Mercer, said a Medicare expansion could also have profound effects on employers and their workers.
“This is the biggest news in this whole reform thing,” he said. “Those 55 to 65 are the most expensive for employers to cover and they pay the most if they have to buy coverage on their own. … Access to medical care is one of the biggest inhibitors to retiring early, and a lot of people are going to be looking at that as an option.”
Although Americans in this age group are more likely to have insurance than those in their 20s or 30s, they often have a difficult time getting coverage because of pre-existing medical conditions.
Depending on how an expansion is structured, Medicare could offer many of these people a relatively affordable alternative to commercial insurance, even if they have to pay more than current beneficiaries because they are “buying in” to the program.
“The price point will be much more affordable than any option they have,” Swim said.