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Obama, Senate Dems Consider Public Health Care Option With A Trigger

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The Obama administration and Senate Democrats are debating a health care reform outline that will insist upon a public option for insurance but leave open the possibility for it to be kicked in via triggers.

Multiple Democratic sources tell the Huffington Post that the White House and key members of the Finance and Health, Education, Labor and Pensions (HELP) Committees are in the process of hammering out key principles on health care reform -- with a meeting scheduled at the West Wing this afternoon. One of the components will be music to progressive ears: that any bill includes an option publicly run health insurance coverage. But it also comes with a caveat that could engender opposition from that very same constituency.

A trigger would pave the way for public option to come into place only after certain market conditions are met -- mainly if private insurance companies are unable to achieve various metrics for coverage within a certain time frame. The proposal would placate many of the private health care actors who consider a public plan the first step towards a single-payer system. Progressives, however, view it as reform in name and not substance.

"This is really, obviously, a mechanism to kill the public plan," said one progressive health care reform advocate. "We will see what comes out, but the fact that they are debating this is problematic."

An official at the White House said he could not immediately confirm the report.

The proposal for a public plan with triggers has been welcomed among some moderate Democrats who want to forge a compromise on what is shaping up as the major fault line on health care reform. Sen. Max Baucus, one of the major players in the debate, has offered his support for this approach. As have Senators Ron Wyden (D-Ore.) and Thomas Carper (D-Del.).

That said, opposition to the proposal is fierce.

"I would have very strong reservations about [a trigger], but I think we have to keep talking," said Sen. Barbara Mikulski (D-Md.), a powerful subcommittee chairwoman on the health committee.

Senator Chuck Schumer has insisted that, if anything, "reasonable criteria for triggering a public plan has already been met."

"Premiums are high," the New York Democrat said, "and either one or two insurers dominate the market. As we've seen with Medicare part D, a trigger option has so far meant no public option at all."

Indeed, as Schumer notes, there is a trigger in the Medicare part D program and, to this date, the conditions have never been met for a public option for prescription drug coverage. The standards were set by private market, all but ensuring that they would remain unreachable. Progressive officials working on health care reform worry that should the same system be put in place for insurance coverage, the same result will occur and public health care will never come to pass.

With additional reporting by Ryan Grim.

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