Poll Positions: America Gets New Hope For Public OptionS

The town hall scare tactics have failed. According to new polling, "57 percent support a public option, 40 percent oppose it," which is good news for the Dems trying to push through legislation. Still, there's a long slog ahead.

Obama has a major stake in making it work - his approval rating has sunk fifteen points among Democrats while the support for the public option continues to climb. However, one of the major problems facing lawmakers is the definition of a public option. Exactly what does a public option accomplish, who will benefit from it, who will be eligible, and who will oversee the plan? Today's Washington Post does its best to make sense of the madness:

Overall, 45 percent of Americans favor the broad outlines of the proposals now moving in Congress, while 48 percent are opposed, about the same division that existed in August, at the height of angry town hall meetings over health-care reform. Seven in 10 Democrats back the plan, while almost nine in 10 Republicans oppose it. Independents divide 52 percent against, 42 percent in favor of the legislation. [...]

There are also deep splits in the new poll over whether the proposed changes would go too far or not far enough in expanding coverage and controlling costs. Twice as many see the plan as leaning toward too much government involvement, but since last month there has been a nine-point increase in the number who say government should be more involved. [...]

If a public plan were run by the states and available only to those who lack affordable private options, support for it jumps to 76 percent. Under those circumstances, even a majority of Republicans, 56 percent, would be in favor of it, about double their level of support without such a limitation.

Fifty-six percent of those polled back a provision mandating that all Americans buy insurance, either through their employers or on their own or through Medicare or Medicaid. That number rises to 71 percent if the government were to provide subsidies for many lower-income Americans to help them buy coverage. With those qualifiers, a majority of Republicans say they support the mandate.

And there's still the little matter of how to pay for all of this. There is a lot of opposition to the plans on the table for a deficit-neutral bill, but perhaps Congress should re-evaluate their stance on not adding to the national debt:

Nearly seven in 10 say they think that any health-care measure would increase the federal budget deficit, a possible concern for Obama. But nearly half of those who see the legislation as growing the deficit also say the increase would be "worth it."

Improving access to insurance would be a major coup for women, who are disproportionately impacted by prejudicial policies and out of control premiums. Luckily, some of us are mad as hell and we aren't gonna take it any more. Newsweek, in a report called "The Cost of Being a Woman" explains:

At a recent Capitol Hill press conference on women and health care reform, Sen. Barbara Mikulski started things off with rallying cry: "Equal insurance for equal premiums!" Four female senators spent the event discussing disparities women face in the individual health-care market, where eight states and D.C. consider domestic abuse a preexisting condition and maternity coverage is often lacking. Chief among concerns about health-care discrimination is gender rating, the health-insurance practice of charging different premiums based on gender. Mikulski reiterated the point on Larry King last Thursday: "Just like we didn't get equal pay for equal work, we haven't got equal insurance benefits for equal insurance premiums." [...]

The issue came to head last year when the National Women's Law Center published a report finding widespread variation in gender pricing, with women charged inconsistently high rates, depending on company and state of residence. A 25-year-old woman, for example, could be charged anywhere from 6 to 45 percent more than a 25-year-old man. "The huge variations in premiums charged to women and men for identical health plans highlight the arbitrariness of gender rating," the report concluded. (It's difficult to tell how arbitrary gender rating is, since insurance companies do not publicize their costs, although there is at least some research finding women cost more to insure then men). Twelve states either limit the use of gender rating or bar the practice outright; others have considered similar methods. Legislators and activists taking up the cause have termed the disparities "gender discrimination."

Proponents of gender rating argue that if you eliminate gender rating (or pricing on any other risk factor, for that matter) and you run the risk of "adverse selection": men, who feel they're paying too much relative to the few benefits they receive, opting out of the system. As the pool becomes more female heavy, men increasingly pull out, to the point that insurance companies no longer have an interest in the market. This played out in Kentucky in the mid-1990s. In 1994, rates for young women were 150 percent that of those for young men. So that year the state passed legislation limiting insurance companies in their ability to charge different premiums based on things like race and gender. Over the next 10 years they saw low-risk individuals-the guys who thought they were overcharged-simply opting out altogether. Then the insurance companies fled, too, about 40 had left the market by 1998. So that year Kentucky largely repealed the program. The insurance companies returned to the state shortly afterward.As the Kentucky experience shows (and similar experiences in other states also demonstrate) small changes in regulation can ripple through a market to have a serious, and not necessarily favorable, impact.

But by no means is Kentucky the rule. Montana, for example, successfully outlawed gender rating in 1993 and never looked back. A dozen states are now managing similar bans or restrictions. And even if some adverse selection does occur, advocates of gender-neutral policies say that's OK-there are larger, philosophical issues at stake. The NWLC report describes how advocates for the Montana and Minnesota bans argued that "society considers gender discrimination to be just as repugnant as racial discrimination," and therefore should drop gender rating, just as they did for race in the 1950s and 1960s.

The whole report is well worth a read.

Not surprisingly, despite the changing tone and direction of the country, the GOP is still hating on progress:

But even now, as the odds grow that President Barack Obama will have a chance to sign a health reform bill, Republicans say they're content to stick by that strategy - believing they can define the Democratic plan as a bad mix of higher premiums, more taxes and cuts to Medicare.

And that, they believe, is a winning formula for them in 2010.

"If they pass this bill, I wouldn't want to be a Democrat standing for reelection in 2010," said Arizona Rep. John Shadegg (R-Ariz.).

Added Rep. Mark Kirk (R-Ill.): "Several dozen House Democrats risk losing their jobs if they vote for reform."

But the Republican strategy also carries clear risks - already opening up the GOP to criticism as the "party of no" from the White House and congressional Democrats. And it lays down the contours of the midterm races in sharp relief, helping to turn them into a referendum on Obama and his ambitious agenda on health reform and other issues.

To be quite frank, becoming the party of "no" may be the least of the GOP's worries. It's already in the running for "party of fools," "party of bigots," or "the angry white man's last stand." And opposing the public option is just one more nail in the coffin.

WaPo-ABC Poll: Clear Majority Favors A Public Option [Politico]
Approval Of Obama Drops Sharply Among Dems As Support For Public Option Rises [The Plum Line]
Public Option Gains Support [Washington Post]
The Cost Of Being A Woman [Newsweek]
GOP: Reform Is Bad Politics [Politico]