Despite coverage gains obtained under the ACA, today, approximately 13% of Americans or over 30 million are uninsured and 43 percent or approximately 115 million Americans are under-insured. Broadly defined, the public option is a government regulated if not managed health insurance plan that pays reimbursement rates comparable to Medicare or significantly lower than commercial insurers. A public option plan was passed by the House during the ACA debate in 2009 but failed in committee the Senate. Forwarding the policy has been pursued since ACA exchanges went into effect in 2013, was supported by candidate Hillary Clinton in 2016 and by the Biden campaign last year. This past month Senators Bennet and Kaine proposed legislation titled” “the Medicare Exchange “or X” Choice Act” that would create a public option plan that promises to improve care quality and reduce healthcare costs for all Americans since lower public option plan premiums would require commercial plans, in turn, to lower their premium costs in order to compete.
During this 30 minute interview Dr. Fiedler begins by defining further the public option, discusses advantages of a public option policy including the extent to which or how the policy expands coverage, potential downsides including reduced provider income, how a public option compares to an alternative price cap policy, where, if at all, the individual mandate fits into the public option debate, chances for a public option policy to pass the Congress this session and states moving public option policy via, for example, ACA 1332 Section waivers.
Dr. Matthew Fiedler is a fellow with the USC-Brookings Schaeffer Initiative for Health Policy. His research examines a range of topics in health care economics and health care policy. Prior to joining the Brookings, Dr. Fiedler served as Chief Economist of the Council of Economic Advisers, where he oversaw the Council's work on health care policy, including implementation of the Affordable Care Act’s health insurance expansions and health care delivery system reforms. Fiedler holds a Ph.D. in economics from Harvard University and a B.A. in mathematics and economics from Swarthmore College.
Information on Senator Bennet (CO) and Senator Kaine's (VA) "Medicare-X Choice Act" is at: https://www.bennet.senate.gov/public/index.cfm/medicare-x.
Information regarding the related Brooking's September 23, 2020 webinar program noted during this discussion is at: https://www.brookings.edu/events/health-care-price-regulation-and-public-options-assessing-approaches-to-increasing-the-public-role/
Brookings' Dr. Matt Fiedler Discusses the Public Option (March 25th)