So far, President Biden has done little to move forward with health insurance reform at the federal level; most states lack the will and the skill to take on the health insurance industry and guarantee affordable health care to their residents. Those few states with the skill and the will to undertake health care reform, appear to lack the power and the resources even to offer their residents the option of public health insurance. We likely will need democracy reform coupled with federal action if we are ever going to get guaranteed affordable health care coverage for all.
So, what’s going on in the states? Julia Rock reports for the Daily Poster. Spoiler alert: Tremendous and effective pushback from the health insurance industry and its allies.
During the last round of health reform, the public health insurance option was intended to be an alternative to private health insurance; it was to be administered directly by the government and modeled on Medicare. It has taken on every which size and shape since then. A true public option should have provider rate regulation, an unrestricted provider network and very low administrative costs. That does not appear to be the model any state is considering.
Washington state was first to pass legislation offering residents a “public option.” But, the option is hardly “public.” It works through private insurers, offering state-administered private insurance to people and it does not require hospitals to accept the public insurance. It has enrolled less than 1 percent of the population.
Washington is now working on a fix, requiring all hospitals that take Medicaid patients to accept people enrolled in its public plan. Will it pass? Will the hospitals accept public option patients?
A public health insurance option was up for consideration in Colorado. Colorado would have relied on a non-profit it established to administer the public plan, which would make it less likely to focus on profit maximization and more likely to focus on good health outcomes than a for-profit insurer. The state would set provider rates and require all providers to accept them. Standardization of provider rates is needed across the country and could be valuable if the rates are set fairly. An unrestricted provider network is also important, particularly for people with complex conditions. But, again, the insurance industry lobbyists succeeded at keeping it from happening.
As it was originally designed, Colorado would give insurers two years to voluntarily lower their premiums before implementing its public option. But, Colorado’s “public option” is not going forward. Instead, under proposed legislation, the insurers will have until 2025 to lower their premiums by 15 percent (after adjusting for medical inflation) in the individual and small group markets. If not, Colorado might regulate payment rates for these insurance plans.
Insurers can make up for lower premiums with higher deductibles. So, it’s not clear to me that the Colorado law accomplished much of anything.
So long as state mandates for a public option rely on private insurers, and these mandates simply define the benefits to be offered and do not define the care that is medically necessary, insurers can delay and deny care inappropriately and with little accountability. And, if the insurers are paid a capitated rate-a fixed upfront amount regardless of the cost of the care they deliver–as they are in Medicare Advantage, they have every reason to delay and deny care. That’s how they maximize profits.
In Connecticut, United Healthcare organized its workers to fight a public option. United felt that it was wrong for the state to set lower provider rates for the public option and, in the process, make corporate health insurance less attractive.
Nearly three in four Connecticut residents support a public option. Of course they do. It sounds like another choice, one that might cost them less. For a huge swath of the US population, even with insurance, critical health care is often unaffordable.
All the insurers based in Connecticut have also let the governor know that they would leave the state if it passed a public option. That could be the best possible outcome for Connecticut residents needing health care. But, the state would lose jobs and taxes, two mainstays.
New York seemed to be on the verge of offering universal coverage to residents through a government-administered public plan. The plan would have no copays, deductibles or premiums. It would be paid for through a progressive tax. But, some big unions oppose it–worried about job losses and losing their value to workers–without considering lives lost for lack of comprehensive health insurance.
California’s legislature refused to hold a vote on single payer, state-administered health care coverage for everyone, in 2017. The Democrats had supermajorities in both houses. And, the governor was also a Democrat.
It’s on Congress to guarantee everyone in the US affordable health care. Already tens of thousands of Americans die each year for lack of health care. Millions more suffer tremendously or face huge medical debt or bankruptcy. What will it take?
Here’s more from Just Care:
- If you’re making a Medicare choice, don’t trust the insurance agent
- Members of Congress sign on to letter supporting Medicare Advantage riddled with misinformation
- More people benefiting from Medicare coverage of advance care planning
- Get the preventive care you need: Medicare pays for it
- Avoid supplements with these 15 ingredients
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