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The White House has reportedly been talking to Sen. Olympia Snowe, R-Maine, about a "trigger option" for health reform. Rather than creating a "public option" government-health-insurance program, Congress would give insurance companies a deadline to expand coverage and lower costs. If the insurance companies should fail to meet it, then Congress would enact a public option.
The idea of a legislative trigger to get Congress to do later something that it doesn't want to do now is not new. Such triggers have an excellent track record of demonstrating resolve where none exists. But as a policy mechanism, they have nearly always failed.
In 1973, Congress enacted the War Powers Resolution. It gave the president 90 days after the start of any armed conflict to receive congressional authorization. If no such authorizations were granted, troops would be required to come home. The resolution has seldom been invoked at all, and Congress has never once imposed a 90-day deadline on any military action.
In 1978, Congress enacted the Humphrey-Hawkins Full Employment Act. Under the act, Congress gave itself five years to reduce the unemployment rate from 6 percent to below 4 percent. If that target was not met, Congress would create a public employment program. Five years later, unemployment was not down but up, reaching a postwar peak of 10.8 percent (significantly higher than it is today). Yet Congress did nothing. Today, Humphrey-Hawkins is remembered not for its full-employment provisions, which were watered down to meaninglessness prior to its passage, but, rather, for its requirement that the Federal Reserve Board make a semi-annual report to Congress about monetary policy.
In 1985, Congress enacted the Gramm-Rudman-Hollings Balanced Budget Act. If a specified "maximum deficit amount" were exceeded, spending (with certain exceptions) would be reduced by a uniform percentage across the board. Congress found ways to evade these mandatory reductions (called "sequestrations"), and the budget deficit rose from $212.3 billion to $220.4 billion in 1990, when the law was finally scrapped.
Legislative triggers have an especially dismal history in health care policy, argues Timothy S. Jost, a law professor at Washington and Lee. In 1996 the Health Insurance Portability and Accountability Act required states to impose health-insurance reforms similar to those proposed in the current health reform bill; if the states failed to act, the federal department of Health and Human Services would impose them. States failed to implement reforms—and so did HHS. In 2003, when Congress added a drug benefit to Medicare, it worried that its new program to provide coverage through private plans subsidized heavily by the government would prove ineffective. But a trigger to end the program focused only on whether these private plans would serve all regions of the country, which they did. The trigger failed to address the real problems that emerged: fraud, abrupt changes in formularies and drug charges after beneficiaries signed up, and high costs. Meanwhile, a separate trigger in the bill required the president to address projected shortfalls within 15 days of receiving notice that 45 percent or more of Medicare funding was drawing down general revenues for a second consecutive year. Congress would then eliminate the surplus spending under an expedited procedure. But when President Bush notified Congress in 2006 that the 45 percent threshold had twice been exceeded, Congress did nothing. The threshold has been exceeded every year since then. Congress continues to do nothing. *