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A primer on the public option proposals

From NBC's Doug Adams
Here's a primer on the various "public option" plans being kicked around the House and Senate:

First of all, it's important to recognize that the House and Senate are working on two different tracks when it comes to a "public option" government run insurance plan. 

The House is more supportive of a strong public option (mainly because Democrats have the numbers to pass a plan and don't have to worry about a filibuster). House Speaker Pelosi is leading a fight for a "robust" public option -- also referred to as "Medicare Plus 5."  What that means is under this plan, doctors and hospitals would be reimbursed for services at Medicare rates, plus 5%.  (Pelosi was forced to admit on Friday that she doesn't have the votes for this plan yet, and the focus now seems to be shifting to other plans.) 

"Medicare Plus 5" is considered too low a payment for some moderate Blue Dog Democrats, especially those from rural states who insist such a low reimbursement rate would make it even harder to attract enough doctors and hospitals to make the plan viable. They favor a second public option plan -- call it "negotiated reimbursement," which is just like it sounds -- payment rate for medical providers would be negotiated, independent of what rate Medicare pays. Some House members also call this the "hybrid" public option plan.

A third option under consideration in the House is the "trigger" option -- which also is being debated in the Senate -- where failure to achieve sufficient savings and affordable coverage after a certain point would trigger the creation of a public plan. House leaders say a public option plan that would be triggered would be the "robust" plan (i.e., Medicare plus 5), but that decision hasn't been fleshed out yet. And there has been almost no discussion in either the House or the Senate on what would define that "trigger." 

The Senate seems to be moving in a different direction on the public option. Support is building for what is called an "opt out" plan, in which states could have the choice to opt out of whatever national public option plan is created. The assumption is that any public option created would be pretty "robust" -- in order to create a healthy competition with private insurers. Major public option supporters like West Virginia Sen. Jay Rockefeller (D) say they could live with an "opt out" plan, and key centrists like Nebraska Sen. Ben Nelson (D) are open to it.

But Olympia Snowe, the lone Republican working with Democrats on health care, favors a "trigger" plan -- and has hinted she does not support the "opt out" idea. That could complicate things, because the White House has made keeping Snowe on board a priority. Having Snowe support the final bill would mean the White House could claim some bipartisanship, and there is a fear that losing her might mean also losing some moderate Democrats.

And one quick note on the magic 60 vote number: Democrats do need 60 votes to overcome any Republican filibuster, but they only need 51 to actually PASS legislation. So in these showdowns, the key is to get 60 senators to vote to break a filibuster, even if some of those senators end up voting AGAINST the underlying legislation.