This afternoon, Sen. Tom Carper (D-DE) appeared on Fox News to discuss a proposal to replace the opt-out public option in the Senate health care bill with a ‘Plan B‘ — a self-sustaining entity established with public dollars in states where private plans don’t offer affordable coverage. Carper stressed that “we’re not sure whether or not we’re going to need a plan B,” and directly addressed the concerns of Sen. Blanche Lincoln (D-AR) and other moderate lawmakers, who are worried that taxpayers would be on the hook if a the public option “doesn’t go well”:

We’re not sure whether or not we’re going to need a Plan B. If we do, we want to have something that we can offer to more conservative folks in our party, more liberal people in our party and maybe one or two Republicans as well….A number of centrists in our party are not interested in government run, government funded after some initial start-up funding. And we want to make sure there is a level playing field so that is a public option available in some states where there is no affordability there is not much competition, affordability is bad. We want to make sure there is a level playing field that doesn’t disadvantage the private sector.

Watch it:

Carper is combining a non-government public option (most likely some kind of nonprofit board) with the trigger proposal and pitching the plan to Sens. Landrieu, Lincoln, Nelson, Lieberman, and Snowe. The plan would compete on an equal playing field with private insurers, receive a start-up loan from the government, would only be available in states that lack affordable coverage and would include “safeguards that make sure that the taxpayers don’t’ end up on the hook if the public option doesn’t go well.”

“We hope by gathering ideas from centrists, and liberals and people in between and some of our Republican friends as well, we hope to gather something that not only gets us to 60 votes but is good public policy and provides us with competition where it is needed,” Carper said.

Asked if the proposal would win the support of Snowe, Carper responded, “I think it’s real important that we have Republican support for the final bill that comes out of the Senate.” “In the end, if she could see her way clear to voting for the bill coming out of the Senate, that might give some of our other Republicans and our colleagues courage as well.”

The Senate health bill allows sates to form “compacts” to sell policies across state lines and permits insurers to market so-called ‘national plans.’ Under the bill, insurers in the individual and small group markets “may offer a qualified health plan nationwide, which is subject to only the State benefit mandate laws of the State in which the plans are issued.” Insurers are required to “provide the essential benefits package and states can enact “a law to opt out of allowing the offering of nationwide plans.”

Progressives maintain that the policy would allow health insurers to circumvent critical consumer regulations and further fragment risk pools. As Jon Walker explains, “these nationwide health plans will, in effect, gut state health insurance regulations and create a race to the bottom. What will likely happen is what happened with the credit card industry — all the card companies moved to the two states with the absolute lowest regulations”:

I can easily envision a scenario in which insurance companies stop selling in-state plans that meet the state benefit requirements laws, and only offer nationwide plans in those states. States that don’t opt out will lose their ability to make sure insurance companies cover what the people of those states think is essential.

Well now, Sens. Olympia Snowe (R-ME), Mary Landrieu (D-LA) and Blanche Lincoln (D-AR) have offered an amendment that would deny states the option to ‘opt out’ of “the offering of nationwide plans.” SA 2859 deletes the state opt out language and adds rating requirements to the plan requirements. If the amendment is adopted, the national plans would be required to offer a standard benefits package and abide by the rating rules in any state the policy is sold (previously, an insurer was only subject to the rate regulations of a single primary state.)

The amendment is a less extreme version of the Republican alternative. A Republican health proposal in the House would have allowed the health insurer to self-designate a “primary state” “whose covered laws shall govern the health insurance issuer” and market policies to other states without adhering “to all of the consumer protection laws or restrictions on rate changes of the state.” In fact, that bill explicitly expanded the definition of ‘State’ to allow insurers to designate the Virgin Islands, Guam, American Samoa and the Northern Marianas as a “primary state.”

After three days of debate without a single vote and with just 22 days until Christmas, Senate leaders of both parties agreed yesterday to vote “on four proposals dealing with two issues: how to guarantee additional health benefits for women and how to squeeze nearly a half-trillion dollars from Medicare over 10 years without adversely affecting older Americans.” [UPDATE: The Vitter amendment reversing the U.S. Preventive Task Force's mammogram recommendation passed was added to the Mikulski amendment, but has not yet passed. This is a modified amendment that only targets the mammogram decision.]

Democrats may be ready to crack down on Republican obstructionism and speed-up the processes (Republicans, incidentally, are denying that they are dragging out the debate while releasing memos instructing senators on how to drag out the debate). Roll Call reports that leadership is considering tabling the GOP amendments, ‘filling the amendment tree,’ filing motions to limit debate, or “incorporating Democratic proposals into the manager’s amendment or a package of amendments that would be voted on at the conclusion of the debate.”

The goal is to vote on the Senate measure before Christmas, “but leaders are beginning to concede that their goal may be out of reach and are promising to work straight through New Year’s Day if they have to.” Democrats plan to replace the opt-out public option with a watered down trigger proposal from Sen. Tom Carper (D-DE) early next week and could vote on an amendment restricting federal funding of abortion by the end of this week. That measure, proposed by Sen. Ben Nelson (D-NE) could be unveiled as early as today, and will likely resemble the Stupak language in the House bill. “It’s as identical to Stupak as it can be,” Nelson told reporters on Tuesday.

Below is a table of some upcoming amendments filed to the Patient Protection and Affordable Care Act:

Number	Sponsor	Description
SA 2826	Bennet	Guaranteeing Medicare Benefits: “Nothing in the provisions of, or amendments made by, this Act shall result in a reduction of guaranteed benefits under title XVIII of the Social Security Act.”
SA 2791	Mikulski	Preventive Care for Women: The Health Resources and Services Administration (HRSA) would determine what women’s services would be exempt from co-pays, and the US Preventative Services Task Force (USPSTF) would help determine other types of preventative coverage.
SA 2791	Murkowski	Preventive Care for Women: Would cover preventative care without co-pays as delineated by “the 2 largest plans (by enrollment) participating in the Federal Employees Health Benefits Program.”
SA 2859	Snowe, Landrieu, Lincoln	Eliminates the bill’s opt-out public option a state’s ability to opt-out of the public plan national plans.
SA 2788	Coburn	Transparency: requires CBO score and CRS report 72 hours before any vote on final passage or a conference report.
SA 2823	Coburn	Amendment would strip a provision extending more Medicaid funding to Louisiana.
SA 2825	Coburn	Bureaucrat Limitation: For each new bureaucrat added to any department or agency of the Federal Government for the purpose of implementing the provisions of this Act (or any amendment made by this Act), the head of such department or agency shall ensure that the addition of such new bureaucrat is offset by a reduction of 1 existing bureaucrat at such department or agency.
SA 2789	Coburn, Vitter, Burr, Hatch	Requires members of Congress to enroll in public option
SA 2800	Cornyn	Bill would not go into effect until it is certified that it would reduce annual health insurance premiums by $2,500 for the average American family.
SA 2807	Cornyn	Eliminates the Medicare Commission.
SA 2808 – ACCEPTED	Vitter	Would invalidate the recent mammogram recommendations from the U.S. Preventive Task Force.
SA 2837	Sanders, Burris, Brown	Replaces existing legislation with a single-payer bill, the American Health Security Act of 2009.
SA 2787	Specter	Health Care Fraud: Creates a six (6) month mandatory minimum for those convicted of committing health care fraud under 18 U.S.C. 1347, where the amount of loss is calculated at $100,000 or more.
SA 2793	Dorgan, Snowe, Grassley, McCain, Stabenow, Klobuchar, Brown, Shaheen, Vitter, Kohl, Leahy, Feingold, Nelson (FL)	Prescription drug reimportation
SA 2795	Leahy, Reid, Kerry, Rockefeller, Lieberman, Feinstein, Feingold, Wyden, Schumer, Cantwell, Lautenberg, McCaskill, Whitehouse, Burris, Kaufman, Bennet, Franken	Antitrust Exemption: Removes health insurers’ exemption from federal anti-trust laws.