Reporting from Washington — When Senate Democratic leaders agreed this week to remove a public insurance plan from their massive healthcare bill, they did more than quash a liberal dream of expanding the government safety net. They effectively pinned their hopes of guaranteeing coverage to all Americans on a far more conventional prescription: government regulation.
The change sprang from a compromise made to placate conservative Democrats wary of a new government program. But shorn of a "public option," the Senate healthcare bill has reverted to a long-established practice of leveraging government power to police the private sector, rather than compete with it.
Despite the resistance among Republicans and conservatives to more government regulation, even the insurance industry has agreed to broad new oversight of their business in exchange for the prospect of gaining millions of new customers.
The expanded regulation of insurance programs ultimately could ripple through the entire healthcare system, affecting how doctors, hospitals and other providers care for their patients.
But the success of this approach may well depend on whether regulators have been given enough authority, a question that has received considerably less attention than the ideologically charged battle over a new government insurance plan.
Democrats in the House and Senate have filled their bills with a dizzying array of rules and regulations on insurers. The insurance market provisions in the Senate bill alone run nearly 400 pages.
For example, the Senate legislation would require all insurers to fully cover federally recommended preventive health services, such as immunizations, colonoscopies and HIV testing.
Insurance companies would be prohibited almost immediately from rescinding policies for people who get sick and imposing lifetime limits on how much they pay for customers' healthcare.
And state and federal regulators would be required to set up procedures for reviewing how much insurers charge customers and whether premium increases were justified.
A more intense round of regulation would begin in 2014, when states set up marketplaces, or exchanges, where insurers could sell plans to millions of people who do not get coverage through work.
