As
the healthcare debate rages on, interest in a public option is
springing up among proponents of the Affordable Care Act, who would
rather refine the law than repeal it.
Republicans argue that the recently passed American Health Care Act
(their current replacement bill for the ACA) would increase coverage,
yet initial analysis from the Congressional Budget Office and other
independent organizations find that millions fewer people would actually
be covered.
So if universal, or near universal, coverage is the goal, what’s an alternative to the Republican alternative?
Some
Democrats, notably Vermont Senator Bernie Sanders, have endorsed a
“public option” within the ACA exchange framework. Here’s what that
means.
What Is a Public Option?
There
are primarily two types of public options discussed in the healthcare
debate: The first is the expansion of existing government programs, like
Medicare and Medicaid. The second is the creation of a new
government-run plan for those under 65, that would compete against
private insurers in the individual market exchanges. We’re focusing on
the latter, since that’s more easily implemented.
An
increasing number of counties in the U.S. (around 20-25%) had just one
insurer option in the ACA exchanges this year, and the number of
counties will likely grow in 2018. The creation of a new public
healthcare plan would intentionally fill the gaps in counties where
insurance options are limited, offering consumers choice and competitive
pricing. The point is to ensure that all Americans in the individual
market have access to an affordable healthcare plan, even if private
insurers raise rates or exit the market.
Ideally,
the public plan would offer the same coverage and benefits nationwide,
with price varying depending on region. But with Republicans in control
of Congress and the White House, it would likely need to be introduced
state-by-state to be implemented soon.
It’s
not a new idea: It was first embraced by John Edwards in 2008, and
subsequent Democratic presidential candidates have also promoted the
idea. When the ACA was written, a public option was included in draft
versions of the bill, but it was ultimately omitted, due to steadfast
opposition from Republicans and withdrawal of support from moderate
Democrats.
Though a public option and single payer
system are often discussed in tandem, they are very different. A public
option is a single plan that would exist alongside private plans, while
single payer refers to an entire public healthcare system. Think of the
public option as Medicare for More, whereas single payer is often
called Medicare for All.
Helen
Halpin, a professor at the U.C. Berkley School of Public Health, says
the introduction of a public option could help transition the U.S. to a
single-payer program down the road. “The premium will be less expensive
and the coverage will probably be better,” she says.
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