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The Carper Proposal

Tom Carper’s state-based public option proposal has received a good amount of attention since it was announced yesterday. The idea goes that each state could choose to (1) use federal seed money to create cooperatives, (2) open up the state’s employee benefit plan to those not on a government payroll, or (3) create a statewide health insurance plan. The third option, effectively a state-based public plan, would also allow multiple states to band together for more effective bargaining power, but would NOT be able to compel providers to participate or tie reimbursements to Medicare rates.

This idea, like any, has its own pros and cons. It would allow states flexibility to structure something that would work for their population, a good thing when considering states like ‘liberal/urban’ California and ‘conservative/rural’ Idaho. It also squashes the notion of a Obamacare federal takeover, as people seem much more comfortable with state-level accountability. Stately alternatives drastically reduce buying power compared to a national plan, though, and buying power without profit-seeking is a robust and streamlined mechanism that could used to drive down skyrocketing costs.

Some have noted that from this angle, more focus should be put on Wyden’s recently passed amendment where states would be able to basically do anything they want as long as they adhere to floors for coverage expansion and cost containment. That’s the cue for single-payer folks to starting jumping for joy, btw.