76% Support Restricted Public Option ... Which Is What's In The Bill

ABC News' polling director Gary Langer makes a notable observation about the W. Post/ABC health care polls from today and June: [1] "[Our] June poll found that support for a public option drops dramatically if it would put many private insurers out of business, as critics claim. This poll shows a flip side: Support for a public option swells to 76 percent if it were available only to people who can't get coverage from a private insurer. The increase is most dramatic among Republicans, a 32-point gain to 59 percent support; and seniors, a 33-point gain to 68 percent."

Langer concludes: [1] "Something like this was suggested by Obama, who said in his address the option would be available only to people who 'don't have' insurance; herein may be a path to compromise."

Obama suggested it, because that's basically how the bills are currently written. This is not a new compromise to be forged. It's what's in the bill.

The polling question is overly simplistic [1], because few in the media have bothered to explain the policy details in the pending bills, that: 1) the public option would only be available as a part of a health care "exchange" -- or marketplace -- featuring good-quality, mostly private, insurance plans, and 2) few who now have insurance would have access to the exchange.

But the underlying message from the public is clear in the polling data: an overwhelming majority supports providing the choice of a public plan, so long as it can't overwhelm the private insurance industry. Healthy competition, not an unlevel playing field, wins the day.

If anything, the bills as written risk tilting the playing field in favor of private insurance by restricting access to the exchange.

As Jacob Hacker explained in his analysis of the various bills in Congress: [2]

In all the bills, the exchange would be open to people without qualified coverage from their employers (qualified coverage would have to meet standards designed to ensure it was affordable and available to all workers whose employers offered it). However, the bills differ with regard to what size of employers can “go into” the exchange—in effect, allowing their workers to choose from among the private plans and the new public plan.

In the House bill, firms with twenty or fewer workers would be able to go into the exchange. Their workers would then be able to choose among the plan options there. A House Education and Labor committee amendment to the bill expands access to the exchange to firms with 50 or fewer employees. The House bill also gives the [Health and Human Services] Secretary the discretion to open up the exchange to larger firms in the future...

...The HELP bill [from the Senate Health Education Labor and Pensions committee], by contrast, leaves the determination of which employers may go into the exchange unsettled. In the HELP bill, states are encouraged to create their own exchanges ... and the states would determine which firms had access to them.

That pretty much restricts access to those who don't have insurance, and some small business employees who do have it but whose employers struggle to provide it.

Hacker is comfortable with these initial restrictions [2] preventing medium and large businesses from ending their own health benefits and sending employees to the exchange, though noting "the Secretary should be granted discretion to consider and implement an opening up of the exchange to larger employers in the future."

While the Washington Post's Ezra Klein is concerned that it's too restrictive: [3] "[The House biill has] a good, strong public plan. And I can't use it. Not even if I want to pay for it out-of-pocket. I work at a large employer and thus I am not allowed to buy into the exchange. A strong public plan on a weak exchange will fail because it won't attain sufficient market share." (As Hacker reminds, "the CBO has concluded that roughly a third of those in the exchange would [choose the public plan], or between 11 and 12 million enrollees.")

Lawmakers may be overcompensating to assuage concerns that private insurance will get steamrolled. But tweaks can certainly be made down the road once we've seen how well reform works after a few years. It's mostly important to get the basic framework established.

But it is clear that the majority of the country wants the assurance that there will be healthy public-private competition.

What hasn't been made clear by pretty much every reporter covering this story is that assurance is already in the bill.