The Path Through Congress
Following President Obama’s inauguration in January 2009, the U.S. Congress began its work on comprehensive health care reform. House Speaker Nancy Pelosi (D-CA) pledged at the time that the House bill would include a public option.
15 Indeed, a public option offered through a private insurance exchange was included in all three versions of the bill passed by House committees in the summer of 2009 (House Ways and Means and House Education and Labor on 17 July 2009; House Energy and Commerce on 31 July 2009), as well as in the bill passed by the full House of Representatives on 7 November 2009 (the Affordable Health Care for America Act, HR 3962). A public option was also included in the bill passed by the Senate Health, Education, Labor, and Pensions Committee on 15 July 2009 (the Affordable Health Choices Act, S 1679).
Senate Democrats were engaged in a highly contentious debate throughout the fall of 2009, and the political life of the public option changed almost daily. The debate reached a critical impasse in November 2009, when Sen. Joseph Lieberman (I-CT), who usually caucuses with the Democrats, threatened to filibuster the Senate bill if it included a public option.
During this period, several alternatives were considered. One compromise proposal included a Medicare buy-in for people age fifty-five and older. However, both Senator Lieberman and Sen. Olympia Snowe (R-ME) opposed the Medicare buy-in, which evoked concerns similar to those raised about the public option. Sen. Kent Conrad (D-ND) proposed using nonprofit health care cooperatives to compete with for-profit plans, but this concept also sparked little enthusiasm.
Debate over the public option continued as additional proposals were made to narrow eligibility for the public option and to raise the rates paid to providers above Medicare levels. When those, too, failed to garner enough support, the public option was eliminated from the Senate bill.
Sen. Charles Schumer (D-NY) and Sen. Jay Rockefeller (D-WV) made last-minute attempts to introduce amendments to include a public option as the bill was about to be voted on by the Senate Finance Committee. Those failed, and there was no public option in either the bill that emerged from that committee or the bill that passed the full Senate on 24 December 2009 (the Patient Protection and Affordable Care Act, HR 3590). The option was also omitted from the president’s proposal, Principles for Health Reform, released 22 February 2010 prior to a bipartisan health care summit. Likewise, it was not present in the budget reconciliation bill passed by the House and Senate and signed into law by President Obama in March 2010.