By Jill Zorn
It is significant that both Barack Obama and Hillary Clinton are talking about a public option.
What is a public option?
Conceived in the run up to the passage of the Affordable Care Act (ACA), it was envisioned to be a government-based health insurance plan, similar to the Medicare program, that could be offered as a choice in the health insurance marketplaces.
Writing about the accomplishments of the ACA and the work left to do in a “Special Communication” in this week’s edition of The Journal of the American Medical Association, President Obama explains why the public option should be put back on the table:
“Some parts of the country have struggled with limited insurance market competition for many years, which is one reason that, in the original debate over health reform, Congress considered and I supported including a Medicare-like public plan. Public programs like Medicare often deliver care more cost-effectively by curtailing administrative overhead and securing better prices from providers. The public plan did not make it into the final legislation. Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited. Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government.”
Hillary Clinton’s campaign echos this in her health care factsheet:
“…consistent with her previous proposals on public options, Hillary will pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan, and to expand Medicare by allowing people 55 years or older to opt in while protecting the traditional Medicare program.”
And the draft Democratic Platform states:
“Democrats will never falter in our generations-long fight to guarantee health coverage as a fundamental right for every American. As part of that guarantee, Americans should be able to access public coverage through Medicare or a public option.”
Brief History of the Public Option
The public option was developed within the context of the failure of the Clinton Health Plan in 1994. It was seen as a more politically achievable alternative to full-fledged Medicare for All single-payer, because it still allowed market competition that included private health insurers.
Richard Kirsch first wrote about the public option in 2003, when serving as the executive director of Citizen Action of New York. Later, Kirsch led the progressive charge for the ACA, including the public option, as national campaign manager for Health Care for American Now (HCAN). Yale’s Jacob Hacker also laid important policy groundwork for the concept.
Whether to include a public option in the final ACA legislation was one of the most contentious aspects of the Congressional debate. “Progressives supported it as a voluntary transition toward single-payer insurance, while conservatives opposed it as a government ‘takeover”’of health care.”
In the end, the public option, opposed by most of the health industry, did not proved to be politically achievable. Although included in the House version of the bill, Connecticut’s own Senator Joe Lieberman blocked its inclusion in the Senate version of the ACA.
Instead, the Senate bill created a much weaker version, state-based non-profit health insurance co-ops. Today, very few of the original 23 co-ops have survived, with Connecticut’s co-op, HealthyCT, likely to be the latest casualty.
SustiNet, Connecticut’s Version of the Public Option
Here in Connecticut, we had our very own version of a public option, SustiNet, a health insurance proposal initiated by Universal Health Care Foundation in 2009. SustiNet would use the purchasing power of both Medicaid and the state employee plan to create a quality, affordable public health insurance plan to be offered to all uninsured Connecticut residents.
A bill authorizing the SustiNet Plan was passed by the Connecticut General Assembly in 2009, over Governor Jodi Rell’s veto, establishing the SustiNet Health Partnership Board and beginning the planning process for the implementation of SustiNet. Responding to the passage of the ACA in 2010, the Board’s final report envisioned SustiNet as an option to be offered both inside and outside Connecticut’s health insurance exchange.
In the end, although pieces of the SustiNet policy were implemented, the major accomplishment of offering a public option to Connecticut’s residents was never achieved.
Whether the Democrats’ raising the public option from the dead is real or an election year get-out-the vote talking point, is not yet clear. But it’s great to see the public option openly discussed once again.