The HELP Committee draft now contains a "strong public insurance option" and a modest employer "pay or play" provision. The announcement came in a letter from Sens. Kennedy and Dodd to the HELP Committee members.

And the complete proposal, also released by the Committee, has been "scored" by the Congressional Budget Office: $611 billion — only a fraction of the $1-5-1.8 trillion CBO estimates of the incomplete draft without the public plan and employer provisions, and well below the artificial $1 trillion target the Finance Committee set.

Key graphs from the letter:

Today, we are circulating language for the two remaining portions of the bill: a strong public insurance option to offer consumers a reliable and affordable alternative, and a provision for the share responsibility of employers.

The Congressional Budget Office has carefully reviewed our complete bill, and we are pleased to report that the CBO has scored it at $611.4 billion over ten years, with the new coverage provisions scored at $597 billion — a significant reduction from earlier estimates. The complete bill virtually eliminates the dropping of currenty covered employees from the employer-sponsored health plans. In addition, our bill, combined with the work being done by our colleagues in the Finance Committee, will dramatically reduce the number of uninsured – fully 97 percent of Americans will have coverage, a major achievement.

Kennedy and Dodd describe the public plan:

– Our public plan will be a national plan, available in each state and territory and administered by the U.S. Department of Health and Human Services, which will negotiate rates and premiums.

– Like private insurance plans, it will be available thorugh the Health Insurance Gateway [what most have been calling the "exchange"]. Enrollees will be entitled to the same tax credits [subsidies to help pay the premiums] as those enrolled in the private plans available through the Gateway.

– And of course, participation in the public option will be just that — an option for American consumers who will be able to decide what plan is best for their families.

The HELP Committee draft appears to deal with the adverse selection issues, by moving money from plans with lower risks to those with higher risks. And it also incorporates a very modest "pay or play" provision:

Americans whose employer chooses not to provide adequate converage will now have an opportunity to get the care they need through private insurance plans or the public option. But those emmployers should still share in the responsibility for ensuring that everyone is covered. So those employers (excluding small firms with fewer than 25 employees) that do not offer health insurance would be assessed a modest annual fee of $750 per full-time worker, or $375 per part-time workers, to help pay for their employees’ health insurance coverage.

I quickly read about half the draft bill last night — tons of details to think about — but some things seem unclear:

– Is the market separated between the employer-based plans and the Gateway (exchange) plans? Market separation limits competition and shields the employer-based plans from competitive pressure. What else does the bill do to "virtually eliminate[] the dropping of currently covered employees from employer-sponsored health plans"?

– There will be multiple Gateways, at least one in every state. The states will run the Gateways, unless they default and the feds take over. There’s going to be lots of variation in implementation timing and rigor. How does this affect our ability to access a "national" public plan?

– The employer contributions for those who don’t offer plans are trivial compared to the costs of providing insurance. The Committee says it wants employers to continue offering/contributing to plans at work, but the incentives send a different signal. What else will keep employers from dumping employees into the Gateway/exchanges?

I hope folks will closely read through the bill, and particularly focus on the public plan and Gateway provisions — around pages 40-85 and sections 3101 through 3106. Here’s the link to the complete bill (h/t HCAN’s Jason Rosenbaum for both links).

I’m on the road today, and will check in later tonight.

And don’t forget to check out the ActBlue ads for Blanche Lincoln.