While progressive lawmakers in Washington are still optimistic that the public option will ultimately be included in the final health care bill approved by Congress, the prospects for a robust government-run plan in the Senate version are looking dim. Last week, two amendments to add a public option to the Finance Committee bill were defeated by a coalition of Republicans and centrist Democrats. If that measure passes out of committee later this week, Senate Majority Leader Harry Reid (D-NV) will have the unenviable task of merging it with the bill passed this summer by the Senate HELP Committee. According to reports from Washington, Reid has not decided on the best course of action, leaving liberal supporters worried.

But as with most legislation, the devil is in the details. And very quietly, Sen. Ron Wyden (D-OR) might have given the robust public option a second life -- at least at the state level. Before the hearings in the Senate Finance Committee even began, Wyden introduced Amendment C8, which offers state legislatures the option to apply for a federal waiver allowing them to implement coverage schemes using federal funds, so long as the state-based program expands coverage, improves quality, and keeps down costs as effectively as the Senate Finance committee bill. In other words, if the federal bill does not include a public option, the General Assembly could establish its own version, one that could be tied to Medicare rates.

It's an idea that could be quite successful in the Land of Lincoln. If the savings were clear and the coverage was suitable, Sargent Shriver National Center on Poverty Law president John Bouman tells us that Illinois could build a large enough pool of enrollees to make the plan feasible. Considering that one private insurer (Blue Cross/Blue Shield of Illinois) dominates the state's health care market, the competition would be healthy for consumers. And because Wyden's amendment would require that the quality of coverage stay on par with national reforms, it's unlikely that the Republicns could gut the entire program if they ever return to power in the state.

But progressive health care wonks across the state also point out that a host of political barriers -- both local and federal -- could impede a push for an Illinois-based public option. "The groundswell of public support would be there," the Campaign for Better Health Care's Jim Duffett tells us, "but it will take some heavy lifting."

For starters, there is no guarantee that the amendment will survive in its current form, even though similar measures were included in some of the House bills. If it did pass, Health and Human Services Secretary Kathleen Sebelius would be tasked with deciding whether state proposals met the coverage criteria, thus qualifying for a waiver. Because this option has not been discussed in public much, we don't know how liberal the Secretary would be in distributing the waivers. It's also not clear how much money the state would receive from the feds to finance their own plan, a crucial detail given the state's gaping deficit. Considering that health care expansion isn't part of the emerging debate over an income tax hike, the majority of support would likely need to come from Washington. In Massachusetts, which launched a largely-successful universal coverage policy in 2006, a prior waiver allowed the state to claim matching funds for non-parental adults, significantly curtailing local costs. Illinois has not taken similar steps.

A public option would also face stiff resistance from some key institutions and players in Springfield. Hospitals and other health care providers are justifiably skeptical about increasing coverage through public means, given the massive problems they have had obtaining timely reimbursement. It's tough to imagine the General Assembly approving the politically-risky approach when they can't even coalesce around a budget that keeps the state solvent. Furthermore, such a bill might not ever see the light of day as long as House Speaker Michael Madigan is still in office. After all, he's risk-averse and largely focused on consolidating power for power's sake.

Political obstacles aside, the amendment would give health reformers in Illinois an opportunity to push for a real public option if Congress ultimately bails on it. And that's better than no opportunity at all.

Image used under a Creative Commons license by Flickr user Steve Rhodes.