Public health insurance option
The public health insurance option, also known as the public insurance option or the public option, is a proposal to create a government-run health insurance agency that would compete with other
As a result, Congress did not include the public option in the bill passed under reconciliation. The public option was later supported by Hillary Clinton and the Democratic Party in the 2016 and 2020 elections and multiple other Democratic candidates, including the current President Joe Biden.[3][4]
History
Federal
The public option was featured in three bills considered by the
President Barack Obama promoted the idea of the public option while running for election in 2008.[7] Following his election, Obama downplayed the need for a public health insurance option, including calling it a "sliver" of health care reform,[8] but still campaigned for the option up until the health care reform was passed.[9]
Ultimately, the public option was removed from the final bill. While the
In January 2013, Representative
In the run-up to the
In the lead-up to the 2020 presidential election, the public option, "once considered too far-reaching", had become "seen as a more moderate alternative" to proposals like Bernie Sanders' Medicare for All plan.[4] A majority of candidates running in the Democratic primary, including Joe Biden and Pete Buttigieg, preferred a healthcare plan that included a public option over a single payer plan, and some candidates who preferred a single payer plan said they would also accept a public option as a compromise or step along the way to single payer, such as Elizabeth Warren, who initially said "there's no excuse for stopping at half-measures" regarding single payer, but would later pivot to supporting the enactment of a public option first before transitioning to a single payer system.[4][19]
State legislation
Attempts to implement a public option have also been made at the state level. In May 2019, a law was passed and signed in Washington for the establishment of a public option, which is the first law for a public option to be passed at the state level, and is intended make a public option plan for purchase in 2021.[20] The Cascade Select program which requires private insurance companies to provide alternative plans, known as Cascade Select plans, which are overseen, but not run, by the state; the alternative plans are sold on the ACA marketplace alongside ACA-compliant private insurance plans. The law caps provider payments on Cascade Select plans at 160% of Medicare payment rates. The Washington state law has been variably described as both a "public option" and a "public-private partnership".[21][22] Similar legislation was passed in 2021 in both Colorado and Nevada.
New Mexico has also passed legislation establishing official studies into a state-level public option and have been pursuing further action, while Delaware, Oregon, and Massachusetts have completed similar studies looking into state-level public options but have taken no additional action, and other state legislatures have considered either outright enacting a public option or at least passing legislation to establish an official study on a potential public option plan.[23]
Rationale
The purpose behind the public option was to make more affordable health insurance for uninsured citizens who are either unable to afford the premiums of private health insurers or are rejected by private health insurers due to pre-existing condition. Supporters also argued (and proposed possible ways) that a government insurance company (public option) could put pressure on private health insurance companies to lower their premium costs and accept more reasonable profit margins, while also encouraging them to create more competitive plans with wider coverage, as well as eventually creating a more competitive, reasonably priced healthcare market across the industry by encouraging more efficient treatments and practices, and finally, eventually generating a large source of non-tax revenue for the government, which could help ease the rate of increasing budgetary deficit. Proponents proposed this would be accomplished by initially paying doctors and hospitals 4%-5% higher for claims than the average paid by private insurers but charging lower premiums than them, thus creating a more widely accepted, competitive product- making it the obvious choice and forcing private health insurers to create their own, similar reasonably priced, more full-featured insurance plans.
A public option would be able to offer such competitive options, as they would not be operating as a traditional
Additionally, government influence and power would be leveraged to encourage (primarily) hospitals (as well as medical groups and collectives) to switch medical workers currently paid directly by insurers on a claim-by-claim basis (i.e. for each individual procedure) to instead work as cooperatively as possible, in efficient teams, and receive income in
Supporters of a public plan, such as
Economist and former
Many Democratic politicians were publicly in favor of the public option for a variety of reasons. President Obama continued campaigning for the public option during the debate. In a public rally in
Alternative plans
The final bill, the
An alternative proposal is to subsidize private, non-profit health insurance cooperatives to get them to become large and established enough to possibly provide cost savings[35][36] Democratic politicians such as Howard Dean were critical of abandoning a public option in favor of co-ops, raising questions about the ability of the cooperatives to compete with existing private insurers.[8] Paul Krugman also questioned the ability of cooperatives to compete.[37]
While politically difficult, some politicians and observers have argued for a
A number of alternatives to the public option were proposed in the Senate. Instead of creating a network of statewide public plans, Senator Olympia Snowe proposed a "trigger" in which a plan would be put into place at some point in the future in states that do not have more than a certain number of private insurance competitors. Senator Tom Carper has proposed an "opt-in" system in which state governments choose for themselves whether or not to institute a public plan. Senator Chuck Schumer has proposed an "opt-out" system in which state governments would initially be part of the network but could choose to avoid offering a public plan.[43]
Opposition and criticism
Both before and after passage in the House, significant controversy surrounded the
Former Congressman and Republican House Minority Whip Eric Cantor has argued that a public plan would compete unfairly with private insurers and drive many of them out of business.[45]
The chief executive of
Public opinion
Public polling has shown mixed support for a public option. A
Between October 28 and November 13, 2009, Democratic senator Dick Durbin's campaign organization polled Americans to rank their support for various forms of the "public option" currently under consideration by Congress for inclusion in the final health care reform bill. The 83,954 respondents assigned rankings of 0 to 10. A full national option had the most support, with an 8.56 average, while no public option was least favored, with a 1.10 average.[61]
Polls during 2019 have shown a majority support for a public option, including a Marist poll which found that 70% of Americans supported a public option while 25% opposed it,[62] a Kaiser Family Foundation poll which found that 69% of Americans supported a public option while 29% opposed it,[63] and Quinnipiac poll found that 58% of Americans supported a public option while 27% opposed it.[64]
Physician reaction
In 2009, a survey designed and conducted by doctors Salomeh Keyhani and Alex Federman of
Conversely, a 2009 IBD/TIPP poll of 1,376 physicians showed that 45% of doctors "would consider leaving or taking early retirement" if Congress passes the health care plan wanted by the White House and Democrats. This poll also found that 65% of physicians oppose the White House and Democratic version of health reform.[67] Statistician and polling expert Nate Silver has criticized that IBD/TIPP poll for what he calls its unusual methodology and bias and for the fact that it was incomplete when published as responses were still coming in.[68]
In 2019, the American College of Physicians, the second largest physicians group in the United States, endorsed both single payer and a public option for US healthcare reform.[69]
See also
- Multi-payer healthcare
- Health care compared
- Health care reform in the United States
- Publicly funded health care
- SustiNet
Notes
- ^ Lieberman: I'll block vote on Reid plan, By Manu Raju, Politico.com, 10/27/09
- PMID 20530340.
- ^ a b Alex Seitz-Wald, Democrats Advance Most Progressive Platform in Party History, NBC News (July 10, 2016).
- ^ a b c Gabriel, Trip (June 23, 2019). "'Medicare for All' vs. 'Public Option': The 2020 Field Is Split, Our Survey Shows". New York Times. Archived from the original on January 13, 2020. Retrieved January 22, 2020.
- ^ Why We Need a Public Health-Care Plan Robert Reich The Wall Street Journal
- ^ e.g. House Bill H.R.3962 Section 322 (b)2(B) "AMORTIZATION OF START-UP FUNDING- The Secretary shall provide for the repayment of the startup funding provided under subparagraph (A) to the Treasury in an amortized manner over the 10-year period beginning with Y1". The Senate HLP Committee bill contains a similar clause in § 3106 "A Health Benefit Plan Start-up Fund will be created to provide loans for initial operations, which the plan will be required to pay back no later than 10 years after the payment is made."
- ^ Wangsness, Lisa (June 21, 2009). "Health debate shifting to public vs. private". Boston Globe. Retrieved September 21, 2009.
- ^ a b Kranish, Michael (August 19, 2009). "Health co-ops' fans like cost and care: But successful models still rare nationwide". The Boston Globe.
- ^ Obama, Congress easing debate on public option - Beaver County Times
- ^ CNN: Senate panel votes down public option for health care bill. September 29, 2009.
- ^ Bankrate: Key details of health reform bills.
- ^ David D. Kirkpatrick, August 12, 2009, "Obama is taking an active role in talks on health care plan", New York Times
- ^ Washington Post: "Obama never secretly killed the public option. It's a myth". November 17, 2011.
- ^ "House Dems push again for creation of government-run health insurance option" The Hill, January 16, 2013
- ^ "Cosponsors: H.R.265 — 114th Congress (2015-2016)" Congress.gov, August 5, 2016
- ^ Hillary Clinton: The Briefing: Hillary Clinton's Commitment: Universal, Quality, Affordable Health Care for Everyone in America. July 9, 2016.
- ^ Truth Out: "Sanders Cites Democratic Platform, Public Option as Basis for Endorsing Clinton". July 13, 2016.
- ^ NPR: Obama Renews Call For A 'Public Option' In Federal Health Law. July 11, 2016.
- ^ McManus, Doyle (November 20, 2019). "Elizabeth Warren's pivot on 'Medicare for all' shows the tricky politics of healthcare". Los Angeles Times. Retrieved January 22, 2020.
- ^ O'Sullivan, Joseph (May 14, 2019). "Washingtonians to get public option on state's health-insurance exchange". Seattle Times. Retrieved January 22, 2020.
- ^ Scott, Dylan (June 17, 2021). "The public option is now a reality in 3 states". Vox. Retrieved January 1, 2023.
- ^ "Cascade Select (public option) | Washington State Health Care Authority". www.hca.wa.gov. Retrieved January 1, 2023.
- ^ Kaur, Simrandeep (September 13, 2019). "States Continue to Explore a Public-Option Plan to Offer Affordable Healthcare". decisionresourcesgroup.com. Retrieved January 22, 2019.
- ^ Salary.com (Accessed: May 2, 2020): "Aetna Inc. Executive Salaries (Data for years 2006-2017)", Aetna.
- Aetna Inc.
- ^ a b Washington Post: 8 Questions About Health-Care Reform.
- ^ Gauvey Herbert, David (January 2, 2011) "Public Option" Archived March 29, 2012, at the Wayback Machine, National Journal.
- ^ Paul Krugman (June 22, 2009). "Competition, redefined". The New York Times. Retrieved October 10, 2009.
- ^ "Robert Reich Public Option Video". YouTube. Archived from the original on December 21, 2021.
- ^ "How Pharma and Insurance Intend to Kill the Public Option, And What Obama and the Rest of Us Must Do". Archived from the original on June 11, 2009.
- ^ "Obama: Public option should be part of reform". NBC News. September 7, 2009.
- ^ Weiner, Rachel (September 9, 2009). "Obama Health Care Speech: FULL VIDEO, TEXT". Huffington Post.
- ^ Houston Chronicle: Jackson Lee predicts "vigorous public option" on health care. July 31, 2009
- ^ CNN: The marketing of Obamacare exchanges begins. June 21, 2013.
- ^ Kranish, Michael (August 19, 2009). "Health co-ops' fans like cost and care: But successful models still rare nationwide". The Boston Globe.
- ^ "Are health care co-ops the answer for reforming the system?" Archived August 22, 2009, at the Wayback Machine Kansas City Star
- ^ New York Times: ""Baucus and the Threshold"", Paul Krugman, September 17, 2009
- ^ Colliver, Victoria (May 30, 2009). "Health care activists lament single-payer snub". San Francisco Chronicle. Retrieved October 10, 2009.
- ^ H.R. 676
- ^ "House Reps Introduce Medicare-for-All Bill" Becker's Hospital Review, February 14, 2013
- ^ Remarks by the President to a joint session of Congress on health care Archived January 15, 2012, at the Wayback Machine
- ^ "Obama on single payer health insurance" Youtube]
- ^ Ezra Klein. "A guide to the public option compromises in the Senate". The Washington Post.
- ^ Alec MacGillis, "Health-care reform and abortion coverage: Questions and answers", Washington Post, November 14, 2009.
- ^ Molly Hooper, "Cantor: Public option poll 'skewed'", Blog Briefing Room, 10/21/09
- CATO Institute. Retrieved October 10, 2009.
- ^ Key Issues in Analyzing Major Health Insurance Proposals (PDF). Washington, DC 20515: Congressional Budget Office. 2008. pp. 69–70.
{{cite book}}
: CS1 maint: location (link) - ^ "Government as 'Competitor': The Latest Prescription for Government Control of Health Care". The Heritage Foundation. August 14, 2008.
- ^ The Huffington Post: "Is the House Health Care Bill Better than Nothing?" Marcia Angell, M. D., November 9, 2009.
- News Hour with Jim Lehrer. August 18, 2009.
- ^ "57% oppose reforming healthcare without including the public option". Rasmussen Reports.
- ^ "50% Oppose Government Health Insurance Company". Rasmussen Reports. July 17, 2009. Retrieved August 28, 2009.
- MSNBC.com. Archived from the originalon August 21, 2009. Retrieved August 27, 2009.
- ^ "U.S. Voters Back Public Insurance 2-1, But Won't Use It". Quinnipiac University. July 1, 2009. Archived from the original on July 3, 2009. Retrieved September 4, 2009.
- ^ "News Poll #15699 "Health Care Data Gathered Using NBC News Wall Street Journal Questions" on 8/19/09". SurveyUSA. August 20, 2009.
- ^ "Mixed Views of Economic Policies and Health Care Reform Persist". Pew Research Center. October 8, 2009. Archived from the original on December 9, 2009. Retrieved October 9, 2009.
- ^ Washington Post: Public option gains support. October 20, 2009.
- ^ Fritze, John (October 27, 2009). "Dems Advance opt-out 'public option'". USA Today.
- ^ Connelly, Joel (November 20, 2009). "New Poll: Voters back, but also fear, health reform". Seattle Post-Intelligencer.
- ^ [1] Archived October 31, 2009, at the Wayback Machine
- ^ Dick Durbin Public Option Poll Results GetActive Software, Inc., November 16, 2009
- ^ "NPR PBS-NewsHour Marist-Poll USA-NOS-and-Tables" (PDF). Marist Poll. Retrieved January 22, 2020.
- ^ "Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage". kff.org. November 26, 2019. Retrieved January 22, 2019.
- ^ "BIDEN RETAKES LEAD AS WARREN PLUNGES, BUTTIGIEG RISES, QUINNIPIAC UNIVERSITY NATIONAL POLL FINDS; VOTERS NOT SWAYED BY IMPEACHMENT HEARINGS". poll.qu.edu. November 26, 2019. Retrieved January 22, 2019.
- National Public Radio. Retrieved October 10, 2009.
- ^ Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H. "Doctors on Coverage — Physicians' Views on a New Public Insurance Option and Medicare Expansion" NEJM • September 14, 2009.
- ^ "45% Of Doctors Would Consider Quitting If Congress Passes Health Care Overhaul". Investors.com. September 15, 2009. Retrieved January 18, 2016.
- ^ IBD/TIPP doctors poll is not trustworthy
- S2CID 210842547.