Others have noted that today Roll Call announced some progressive House members have signaled their willingness to consider a "trigger" attached to any Public Option plan included in a final health care bill:
Liberals stressed that the shift does not amount to an abandonment of their commitment to a "robust" public insurance option. They said they would only support a trigger if that approach guaranteed the same access, quality and affordability.
A trigger will not in any way guarantee "access, quality and affordability," and these House members know it. They know that if a trigger is included in the final bill, and if and when the conditions meet the law's criteria for pulling that trigger, the House will solve the problem by simply killing the trigger rather than comply with it.
How do I know this? Because this same Democratic House already "killed" the Medicare Part D trigger.
When the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was implemented, a trigger was included as part of the package. This trigger was called "the 45 percent trigger" and the law mandated that "in the event that 45% or more of Medicare’s funding comes from general tax revenues for two years in a row, that the president submit, and Congress debate, legislation to slow spending."
More specifically, the Center of Budget and Policy Priorities states:
The 45-percent limit requires each annual report of the Medicare trustees to include an estimate of whether general-fund revenues will finance more than 45 percent of total Medicare expenditures in any of the following six years.
If trustees’ reports issued in two consecutive years estimate that the 45-percent limit will be exceeded within the next six years, a "Medicare Funding Warning" is issued, and the President must submit — and Congress must consider — proposals to prevent the limit from being exceeded.
The Medicare trigger was a joke from the get-go of course because while the President is required to submit proposals under the trigger, the Congress doesn't have to accept them.
Nonetheless, based on Medicare trustee reports from 2006 and 2007 that showed general tax revenues were accounting for more than 45% of the funding for Medicare, the trigger was pulled in 2008:
Both the 2006 and 2007 trustees’ reports contained a projection that the limit would be breached within the next six years. As a result, when the 2007 trustees’ report was released, the 45-percent trigger was pulled, and a "Medicare Funding Warning" was issued.
The primary reason the Medicare trigger was reached was because of high costs and Pharma subsidies associated with the prescription drug coverage under Part D:
We have reached the Medicare 45% Trigger in large part because the prescription drug benefit was funded only by general revenues (except for premiums for Part D plans). That means that the billions of dollars in new expenses that fund Medicare Part D are applied toward the 45% limit. Generally, payroll taxes that go into a trust fund pay for Part A Medicare services, such as hospitalization and skilled nursing care. With respect to physician visits, medical equipment, and prescription drugs provided under Parts B and D, premiums pay for about 25 percent of the costs while general revenues pay for about 75 cent.
As required by law, then President Bush proposed legislation to comply with the trigger on February 27, 2008. Granted (and certainly no surprise), Bush's proposal sucked. Bush ignored the prescription drug subsidies problem and set his sights on undermining the Medicare program as a whole instead:
According to the administration, the legislation (H.R. 5480/S. 2662) takes an approach to strengthening Medicare that includes limits on means testing for Part D premiums and medical liability costs; improved health information technology and electronic medical records; transparency in price and quality information; and incentives for providers to deliver and Medicare beneficiaries to choose high-quality, low-cost health care.
At the same time, the president’s fiscal year 2009 budget proposes more than $182 billion in cuts to the Medicare program over five years, $137 billion of which would come from hospitals.
All hell broke loose. But instead of taking more than a passing swipe at the specifics of Bush's proposed drastic cuts in Medicare and taking the opportunity instead to talk about the huge tax-payer funding subsidies given away to big Pharma in Part D, Democrats and other Medicare supporters began to attack the trigger itself.
House Energy and Commerce Committee Chair John Dingell (D-Mich.) called the Medicare trigger "little more than a scare tactic to promote cuts to the most successful program of our time." The Center for Medicare advocacy called the trigger "entirely arbitrary." The Center of Budget and Policy Priorities called the trigger an "arbitrary benchmark laden with ideological overtones and inconsistent with Medicare’s basic financing structure." Judith Stein, in a commentary for Neiman Watchdog, said, "The 45% Trigger creates significant obstacles to an array of options to improve and stabilize Medicare."
Discussions surrounding the trigger debate quickly became more of a political battle than a policy debate. And in July 2008, House Democrats put the trigger on hold and ended debate.
At the time, I'm sure it made sense to the Democrats to put a hold on trigger requirements that would give President Bush his chance to gut Medicare once and for all. But wait. The Democrats got a second and better chance to take take action in a much improved Congressional makeup the next year.
After the November 2008 elections, Democrats had won the White House, a strong majority in the Senate, and firm control of the House of Representatives. What did they do in response to the Medicare D trigger which could not be held off any longer? They included a one-line item in their rules package stating that the Medicare trigger "shall not apply during the 111th Congress":
January 8, 2009: The House on Tuesday voted 242-181 to approve an operating rules package (H Res 5) that eliminates the Medicare trigger, which requires the president to submit a plan to contain Medicare costs if they reach a certain level.
Steny Hoyer (D-Md.) explained:
the trigger is "an ideologically driven target based on a misleading measure of Medicare's financial health."
ideologically driven target? Wouldn't ANY trigger be based on ideology?
The Democrats didn't like the Medicare trigger, even though it gave them the opportunity to debate (as required) ways to remedy the massive prescription drug subsidies and lower drug prices. So they simply killed the trigger. What do you think will happen when (and if) a trigger is attached to a Public Option in a health care bill and the trigger conditions are met?
We are fighting Democrats and Republicans who are filling their coffers with cash from the insurance corporations. They insult us as fools by even suggesting a trigger would ever get out of the barn.