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Louis Jacobson
By Louis Jacobson March 26, 2010

It's official: The public option is dead

To the dismay of many liberals, the final health care bill signed into law by President Barack Obama did not include a public option.

Advocates had argued that a government-run insurance plan would keep private insurers honest by competing with them so they couldn't charge unfair rates for basic services. Opponents countered that the public option would have presented too much government involvement in the health care system.

But while the House of Representatives approved a bill with a public option, the Senate, after flirting with the concept, chose not to follow suit. When the House went on to pass the Senate version, House Democratic leaders went along with the Senate's version.

The reason for not including a public option was pretty simple. When an audience member at a March 25, 2010, speech in Iowa City, Iowa, asked why the public option wasn't included, Obama responded, "Because we couldn"t get it through Congress, that"s why."

So we rate this Promise Broken.

Our Sources

Angie Drobnic Holan
By Angie Drobnic Holan January 8, 2010

Fate of public option looks dubious

As Congress moves toward final negotiations for a health care bill, the fate of the public option is looking more dubious.

President Barack Obama downplayed the importance of a public option in a final health care bill, saying he "didn't campaign on a public option," a statement we rated Barely True.

Though the House of Representatives approved a bill with a public option, the Senate rejected the proposals. Speaker of the House Nancy Pelosi, when asked by reporters about the issue, seemed to acknowledge that a public option might not make the final bill. The goal of the public option, she said, was "to hold the insurance companies accountable and to increase competition. There are other ways to do that, and we look forward to having those discussions as we reconcile the bills."

The public option was considered something of an insurer of last resort. People who have to buy their own insurance, without the help of an employer, would be allowed to select a public option on a proposed new health insurance exchange. The public option would be run by the government and offer basic coverage. Advocates said the public option would keep private insurers honest by competing with them so they couldn't charge unfair rates for the basics. Opponents said it was too much government involvement in the health care system, among other criticism.

Because Obama has publicly downplayed the public option and Pelosi has said congressional leadership is looking at other options, we rate this promise Stalled.

Our Sources

Angie Drobnic Holan
By Angie Drobnic Holan August 19, 2009

We add the public option to our campaign promises database

This week, alert readers asked us how we were rating President Barack Obama's stance on the public option. That's a promise, right? they asked.

Well, no. We looked in our Obameter database for a promise the public option and couldn't find one.

We were surprised at first. After all, in recent days it feels like we hear the term "public option" a million times.

We are now adding a promise on the public option to our database. But make no mistake: The public option was rarely debated or even mentioned on the campaign trail. When we dug into the campaign record, we found the concept didn't receive much scrutiny prior to this summer.

In looking into the public option's history, we first turned to Obama's health plan from the campaign. The public option doesn't merit even a bullet point in that document. It's mentioned in passing, and most prominently on page 5 under the heading, "New, affordable, accessible health insurance options." Here's what that section says:

"The Obama-Biden plan will create a National Health Insurance Exchange to help individuals purchase new affordable health care options if they are uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be provided for people and families who need it. Insurers would have to issue every applicant a policy and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency. Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange would evaluate plans and make the differences among the plans, including cost of services, transparent."

There was a good bit of news coverage about the idea of creating an exchange: We made it a promise and included it on our list of Obama's Top 10 promises that we published right before his inauguration. But the public option received much less attention. We found very few news reports during the campaign mentioned it as part of Obama's plan, with a notable exception being a New York Times story published on May 30, 2007, headlined, " Obama calls for wider and less costly health care coverage. "

What was the big news during the campaign? In the Democratic primary, it was the notion that all adults should be required to have health insurance, a concept known commonly as the individual mandate. Candidates Hillary Clinton and John Edwards' health plans both included the individual mandate. Obama's did not, and he often highlighted this difference, particularly claiming that Clinton would force people to buy coverage whether they could afford it or not.

Fast forward to July 2009, and Obama switched position with little fanfare, saying he now accepted the individual mandate. From a policy point of view, it's among Obama's most significant reversals from the campaign. Yet we seen virtually no protest of his switch, at least thus far. (If you've seen any, e-mail us at [email protected] ) We rated his move a Full Flop on our Flip-O-Meter .

In fact, in a search through the news database Lexis Nexis for coverage of the public option, we found that coverage of it exploded this summer. Major newspapers produced about 450 significant stories or op-eds on Obama and the public option in June, July and part of August. That's in contrast to about 50 items published between January and May, and about 70 items during the campaign and months prior to the inauguration. The contrast was similar for broadcast transcripts.

At any rate, we are now adding the public option promise to our database. A lot of political coverage in recent days has focused on whether the White House has waffled in its support of the public option, but we don't think their public statements are specific enough to move this promise to Stalled. The public option is still part of bills being considered in Congress, and as long as it is, we rate the public option In the Works.

Our Sources

Obama health care plan

New York Times, "Obama calls for wider and less costly health care coverage," May 30, 2007

Lexis-Nexis news articles database

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