In it, but not of it. TPM DC

Democrats Agree To Tentatively Trade Opt-Out For Trigger, Medicare Buy In, And More


That buy-in option would initially be made available to some uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized--people will have to pay in without federal premium assistance--and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

It appears as if liberals lost out on a Medicaid expansion that would have opened the program up to everybody under 150 percent of the poverty line. That ceiling will likely remain at 133 percent, as is called for in the current bill.

In addition to the new insurance options, the group has tentatively agreed to new, and strengthened, insurance regulations, which the aide could not divulge at this time.

As with the process Senate Majority Leader Harry Reid undertook in merging the Senate Finance Committee and Senate HELP Committee bills, CBO will evaluate a menu of options, some of them interchangeable, so there's no certainty that this list won't change in the coming days. However, a separate senior leadership aide says that all of the options sent to CBO include the (triggered) public plan. Reid and other senators declined to offer specifics earlier tonight, as part of an agreement with CBO not to publicly discuss the policy options on the table while actuaries analyze competing ideas.

Now it's a question of what the CBO says, and then: will Joe Lieberman object to the trigger? This trigger seems awfully hard to pull. But he's said he'd filibuster any kind of government insurance option--even triggered--in the past. And if he's out, what will Olympia Snowe do?

Late Update: The White House sends over a thumbs-up.

About The Author


Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight and the debt limit fight. He can be reached at