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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Public Option Health Care at the State Level: Problems and Prospects

The Medicare for all cause has been derailed by grim political realities and distractions, including Covid, conservative Democrats and now Ukraine. In addition, experiments with state level ‘single payer’ systems have also tanked, Jean Yi reports at FiveThirtyEight. But Yi’s article also provides a more encouraging discussion of the possibilities for the public option at the state level. as Yi, writes, “Americans may have an appetite for a public option, or government-run health insurance that people can opt into at the state level.”

Yi explains that ” Three states (Colorado, Nevada and Washington) have already passed a public option. It’s not single-payer health care reform, but it’s possible that we might see more states adopt their own public-option reforms…..Colorado and Nevada, for instance, successfully passed a public option in 2021, joining Washington, which passed one in 2019. Colorado’s success in advancing a public option is particularly striking, given that almost 80 percent of people voted against its single-payer proposal in 2016.” Further, Yi writes,

To be sure, though, efforts to implement a public option aren’t without their own challenges. In 2021, during its first year of implementation, Washington state’s public option struggled to enroll people and get health care providers to agree to lower payment rates. State lawmakers have tried to fix this problem by introducing legislation that would require more providers to participate and bring down premiums by increasing subsidies. Proponents have also cautioned that it might take years before the public option really gains a foothold with Washington state residents.

It’s not clear yet how successful these state-run public option plans will be, but it is possible that a public option may prove more popular than single-payer. For starters, while single-payer health care is popular among Democrats, the public option still polls much better among Republicans and independents. According to a Morning Consult/Politico poll from March 2021, the public option was roughly as popular as Medicare for All among Democrats — about 80 percent said they supported each. But support for the public option was much higher than support for Medicare for All among both Republicans and independents. Just 28 percent of Republicans and 50 percent of independents supported Medicare for All versus 56 percent of Republicans and 63 percent of independents who supported a public option.

Moreover, a public option may align more naturally with Americans’ existing views on the role of government in health care. Polls have long found that Americans still want a choice in their health care, even though they believe that providing health insurance to the uninsured is the government’s responsibility.

Ultimately, any health care reforms would be easier to implement on a federal level than a patchwork, state-by-state approach. But Washington, Colorado and Nevada remain important tests of state governments’ ability to implement a public option in lieu of action by the federal government. It’s not single-payer, but it’s still some of the most consequential health care reforms in decades — and a potential sign of where the debates over health care are heading.

The old cliche about states being “laboratories of democracy” has limited application when it comes to providing decent health care for all citizens. But the public option at the state level, which is based on giving consumers a choice between public and private insurance coverage, may have a brighter future — particularly if the experiments with it in CO, NV and WA have a good track record in a couple of years. If that happens, Democrats can lead the way forward.

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