At Long Last: Le Trigger D'Olympia Snowe [R-ME]

Ezra reporteth - and it smells like "we're fucked!"

What this says, basically, is that the public option triggers into existence in a particular state if there aren't two or more health insurance plans that cost less than 13 percent of a family's income (or a bit less below 300 percent of the poverty line).

Color me unimpressed. I could imagine a stringent trigger that becomes more aggressive with each passing year: Start at 13 percent of income, say, but by 2019, it needs to be 11 percent of income, as the idea is that insurers need to be competing to bring down costs. But this isn't that trigger. It's also hard to see a public plan in a couple of states wielding much power. It would be better if, say, five states failing to meet the affordability threshold triggered a national public option. But, again, this isn't that trigger.

The "bright" side -- if you want to call it that -- is that health-care costs are going to continue to rise faster than incomes. Within a decade or so, it'll be likely that very few states will have comprehensive policies costing less than 13 percent of income. In that scenario, the trigger does produce a bunch of public plans, at least over the long run.

But in that scenario, the plan is in all sorts of trouble, as the individual mandate is too stringent, and the subsidies are ineffective, so it's a bit hard to say what changes get made. My sense is that Olympia Snowe does not, in fact, want 50 public plans, but that does look like the long-term outcome of the trigger. The question, I guess, is how ingenious insurers will be at creating crappy plans that don't cover much but provide two "affordable choices" to delay the trigger. That doesn't seem like a good incentive for the system, but it's definitely there.