10/29/09 HC Reform Update by Mark Sanna: Speaker Nancy Pelosi’s fallback public option is to have the secretary of health and human services negotiate rates with health care providers as private insurers do. The Congressional Budget Office considers this so weak that it might attract only 6 million of an estimated 30 million people buying insurance on the exchanges in 2019. Its premiums might exceed the average private plan, in part because the sickest people might migrate to the public plan.