After a meeting with Democrats on the Senate Finance Committee, Sen. Tom Carper (D-DE) discussed the status of the public plan in the Senate health care bill with reporters. Here's what he said:
"I think at the end of the day there will be a national plan probably put together not by the federal government but by a non-profit board with some seed money from the federal government that states would initially participate in because of lack of affordability. The question is should there be an opportunity for states to opt out later on and if so, within a year, within two years, within three years?"
How would this plan work? "Among the things that's important," Carper said, "is, one, that this not be a government run, government funded enterprise, two, that there be a level playing field so that this non-profit entity that would be stood up would have to play by same rules basically as for-profit insurance companies--the idea that secretary of Health and Human Services [will be] running or directing the operation of this--no way.
We ought to have a non-profit board--it could be appointed by the President but a non profit board. They'd have to retain earnings, create a retained earnings pool, so that if they run into financial problems later on the financial needs of the plan could be met by the retained earnings, not by the federal government.
Carper suggested that a state's ability to opt out could be determined by the effectiveness and competitiveness of its insurance market. "There should be some standard--how do we say to a state, 'No you've got to participate in it right from day one,' and if so should there be an opportunity later on for you to say, 'Well, it's not working, we don't want to continue to be a part that,' and to opt out."
I pressed Carper on whether this entity would be accountable to taxpayers. He didn't answer directly--clearly there's some interest in de-emphasizing the government's role in the insurance market--he did sugest that the public option, though run by a non-government entity, would answer to the government.
And that would appear to bring it into line with the demands of the largest health care reform campaign in the country