A proposal being put forward by leaders in the House would create a public plan on the same footing as other insurance plans. For example, public and private plans alike would have to adhere to the same benefit requirements and insurance market reforms, and would have to be financially self-sustaining based on premiums. This proposal would not require participation by physicians but initially would use payment rates similar to those of Medicare.
Rates would be unlinked from Medicare rates over time as other payment mechanisms were developed.
In the Senate, an approach getting a lot of attention is to create not a public plan but rather a federally chartered, nonprofit cooperative plan, Ms. Stoll said. This proposal is seen by many as a compromise between a government-run plan and no public plan at all.
Overall, the discussion on a public plan is heading in a direction that is positive for physicians, said Elizabeth Carpenter, associate policy director for the Health Policy Program at the New America Foundation, a nonpartisan think tank.