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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Winning Support for a Public Option Through a Medicaid Buy-In

Jordan Weissman explains why “Every Democrat Should Talk About Health Care Like Amy Klobuchar Does” at slate.com. Weissman quotes Sen. Amy Klobuchar at a CNN town hall, in which she plugged Sen. Brian Schatz’s health care reform bill, which lays the foundation for a public option through Medicaid buy-in:

What we need is to expand coverage so people can have a choice for a public option. And that’s a start. And you can do it with Medicare. You can do it many ways. But you can also do it with Medicaid, something I don’t think we’re talking about enough as a potential solution. This is a bill that I am one of the original sponsors of, Sen. Sanders is also sponsoring it, it’s a bill by Brian Schatz, who is a senator from the state of Hawaii, and what it basically says is “Let’s expand Medicaid so you can buy into Medicaid, and it’ll bring the prices down, and we can cover more people.”

Weissman praises Sen. Klobuchar for the way she frames the proposal “if you didn’t particularly like the substance of Klobuchar’s response, I think she deserves credit for being forthright; Democrats would be better off if more candidates talked about health care with her level of candor.” No matter which candidate you support, Klobuchar’s respectful tone could prove effective in winning popular support in the 2020  general election.

But Schatz’s bill is not intended as a final substitute for ‘Medicare for All,’ the health security reform brand most frequently associated with Sen. Bernie Sanders, who just entered the race for the Democratic presidential nomination as a leading candidate. Schatz’s billI is more of an interim reform on the path to universal health care coverage, one which may have some appeal to moderate Democrats, who are looking for legislation that could pass sooner than any of the ‘Medicare for All’ bills. Weissberg highlights some of the key features of the legislation:

…It would allow states to create public health insurance plans through Medicaid, with premiums capped at 9.5 percent of a family’s income. The policies could be sold on Obamacare’s exchanges and states would be free to include copays and deductibles. In states that adopted it, residents would be guaranteed access to health insurance priced at no more than one-tenth of their income; that’s progress from today’s status quo, where families that earn more than 400 percent of the poverty line have to pay the full cost of insurance, no matter how high premiums rise, and counties can be left without coverage options if private insurers decide to bail. It would also make Medicaid payments to primary care doctors more generous, which could encourage more physicians to accept it. And by working through Medicaid, it avoids the usual Republican attack that Democrats are somehow going to destroy Medicare by expanding it.

Part of the appeal of a public option is that it won’t alienate most voters who want to keep their health insurance, while it allows those who want a public option to try it out. Critics of the approach argue that the economics of universal coverage requires “all-in” participation. No matter which reform is eventually adopted, however, there will be unforseen problems and glitches that need to be fixed. Democrats should acknowlege that reality with an up-front commitment to making the needed repairs, while reminding voters that the Republican “reform” means letting insurance companies have their way with consumers.

Of course nothing is likely to pass before 2021, and then, only if Democrats win a Senate majority and the white house in the 2020 elections. If Democrats win by a landslide margin, a Medicare for All bill will become a practical possibility. If the margin is narrower, the Medicaid buy-in public option may be the more realistic possibility in the short range.

Either way, Democrats should not get suckered into internicine warfare between Medicare for All advocates and supporters of a public option through Medicaid buy-in. Don’t let the debate degenerate into a bitter false-choice exercise. Whichever approach gets prioritized after the election, it’s likely that it will win near unanimous support from Democratic Senators and House members in the final floor vote. Once it is passed, the other alternative will top the Democratic reform agenda. Indeed, expanding eligibility for both Medicaid and Medicare merits support from all Democrats as essential steps toward universal coverage for every American and all illnesses.

2 comments on “Winning Support for a Public Option Through a Medicaid Buy-In

  1. pjcamp on

    “Either way, Democrats should not get suckered into internicine warfare between Medicare for All advocates and supporters of a public option through Medicaid buy-in. Don’t let the debate degenerate into a bitter false-choice exercise. ”

    With Saint Bernie in the race? Right.

    Reply
  2. Victor on

    So in essence instead of building on the movement for Medicare for All of these past two years we would essentially go back to the questions of 2009…

    The experience of 2009 is that if you start conversations all the way in the center left you end up in the center right.

    Democrats need to grow in conservative states and the best option for this is national health insurance. Deductibles and copays also need to go.

    Otherwise you are just condemning people to more of the same, which is what Obamacare did.

    Reply

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