If Tom Harkin is right that there are 52 votes in the Senate for a robust public option, then we should be able to get at least a version of it that has an opt-out provision for the states. The strategy I would pursue is as follows.
First I would float the idea that Reid is going to include the full robust public option that is contained in the House versions and in the Senate HELP version of the bill. Along with that, I’d leak the idea that there are 52 solid votes in favor and that any Democrat who isn’t willing to vote for cloture is at risk of having their committee chairs taken away in the next Congress.
Having made this threat, I’d then offer three things to the ‘centrists.’ First, I’d offer to include an opt-out provision for the states. Second, I’d offer to add some extra money for Medicare reimbursement rates in rural areas. Third, I’d assure them that they could introduce amendments to strip the public option out of the bill. Their choice would be to take that deal and vote for cloture, or we’d be going to the budget reconciliation route that only requires 51 votes. In other words, the ‘centrists’ will not be dictating the final terms of the bill, but they can get some political cover for their votes and a little assistance to address their concerns about reimbursements rates.
Assuming that we got agreement for cloture, we’d pass a version in the Senate that included a robust public option tied to Medicare rates, but with adjustments to those rates in rural areas, and an opt-out provision for the states.
Once the bill goes to the Conference Committee, I’d remove the opt-out provision and dare the ‘centrists’ to vote against it.
I’m pretty sure the momentum is there, and the votes, to get this done.
Another issue that will probably turn out to be just as important is the financing. I prefer the ‘soak the rich’ approach of the House to the ‘tax the cadillac plans’ approach of the Senate. But that is totally negotiable to me if it helps get a robust public option and a successful cloture vote.
This isn’t rocket science. I hope Reid can figure it out.