The Fight Over the Public Option Is Already Here

The public option’s cousin, Medicare for All, looms over the debate. Photo: Irfan Khan/Los Angeles Times via Getty Images

Joe Biden told voters he was the right president for the pandemic: He’d get shots in arms, stimulus checks in bank accounts, and a superior health insurance plan in front of consumers. “If your insurance company isn’t doing right by you, you should have another, better choice,” his campaign website promised. Biden wants a “public option that would give many Americans younger than 65 a chance to buy into a Medicare-like program administered by the federal government. Legislation re-introduced by Democrats in the Senate last month would phase in over time a public option called Medicare X.

As long as the filibuster remains in place, Medicare X has an uncertain future in the Senate. But Senate rules aren’t the only threat to its existence, and neither are Republicans. Already, battlelines are emerging in what may become the biggest healthcare fight since Obamacare.

The nonpartisan Partnership for America’s Healthcare Future has already reserved TV slots for new ads against Medicare X in Maine, Montana, and in the Washington D.C. area market, presumably to influence key senators. “Politicians have proposed a new idea called a public option. The problem is the costs of the public option aren’t optional,” one ad warns. Annual payroll taxes could increase by $2,500, it adds, a figure drawn from research it co-sponsored with the conservative Hoover Institution.

The group’s sister organization, the Partnership for America’s Health Care Future Action, has also begun airing ads against a public option in Colorado, where Democratic lawmakers plan to try to pass legislation this year. Websites targeting voters in Connecticut and Nevada also recently appeared, all with the Partnership’s branding. The Partnership says it simply wants to educate voters with the facts, said Lauren Crawford Shaver, the group’s executive director and a former Obama administration official.

Both the public option and, Medicare for All, its distant relation, are “just bumper sticker slogans,” Shaver said. “And polling, as everyone’s polling tells us, once you dig into the details that not everyone wants to endorse them or support them.”

Polled support for Medicare for All does vary based on how the questions are phrased. But the baseline trends don’t exactly point to a groundswell of public opposition against either Medicare for All or a public option. Last April, as the pandemic began to hit its stride, a poll from Morning Consult found that support for Medicare for All had climbed to 55 percent. In August the same year, Data for Progress discovered an identical level of support for a public option plan that eliminated deductibles. Fifty-two percent supported a public option that would automatically enroll uninsured individuals into the plan.

If public opinion isn’t set so firmly against a public option, why, then, does the Partnership oppose it? Maybe it’s because partner groups don’t want competition from the U.S. government. The Partnership’s members include a number of private health insurers, including Blue Cross Blue Shield, and hospital chains whose profit margins may be threatened by lower rates they would bill to a public insurance plan.

Wendell Potter, a former Cigna CEO turned healthcare reform advocate, said that his organization, the Center for Health and Democracy is prepared to debunk what he describes as “BS” from groups like the Partnership. “We’re calling out just what that outfit really is, a front group that is funded by the insurance and the hospital industries primarily,” he said, “and to take apart, point by point, what they are saying and showing how it’s misleading, how they are specifically leaving out important details.”

While the Partnership believes the public option is an unnecessary “one-size-fits-all” plan, Potter says it will actually give people another choice. “It’s not unlike the way Medicare beneficiaries have now,” he said. “They have a choice of enrolling in the traditional Medicare program or enrolling in a privately owned and operated Medicare Advantage plan.” That set-up appeals to insurance companies now, he added, but a public option threatens them. “They don’t want to have any competition for people who are younger. That’s why they’re really opposed to having a government operated health plan, because they know that it could operate much more efficiently and would force them to be more vigilant about bringing the cost of both health care coverage and health care costs down.”

Shaver, meanwhile, dismissed fears of competition. The idea is “hilarious,” she said. But there’s no denying the ferocity with which the Partnership and its partner industries fight both the public option and Medicare for All. The Partnership is campaigning preemptively against public options in three states now, all while preparing itself for a federal battle over Medicare X. Instead, Shaver said the Partnership supports the Affordable Care Act, along with “programs that strengthen Medicare, programs that expand Medicaid, that shore up the exchanges and increase subsidies for people to have access to them, that help find efficiencies and strengthen employer-sponsored coverage.” That would exclude all major health care reform, and leave private insurance relatively unscathed.

To private insurers, a public option may be a threat. But even as groups like Wendell Potter’s prepare to defend the public option against certain onslaught, some left-wing critics of the public worry about weaknesses in the structure of the proposal. National Nurses United, the nation’s largest union of registered nurses, opposes a public option because it won’t do enough to rescue a collapsing health care system, said Carmen Comsti, a regulatory policy specialist for the union. “I think one of the things that really concerns us both at the state level and federally with the public option is that it really entrenches the private health insurance system,” Comsti added. Comsti pointed to the example of Washington state, where legislators hoped to cut health insurance premiums by passing a quasi-public option in 2019. The state offers publicly-managed plans via five major insurance carriers.

By 2020, though, health insurance premiums had yet to fall. Blame lies at least partly with the hospital and private insurance industries, which lobbied successfully to water down the original proposal. It’s not hard to imagine a similar fate for Colorado’s possible bill, or for Medicare X – especially if there isn’t a groundswell of support for a public option.  “There is no mass movement in Colorado of people fighting for a public option. There is a grassroots movement of people fighting for Medicare for All,” said Jasmine Ruddy, the union’s lead Medicare for All organizer.

While Potter and the union disagree on tactics, they’re united in the belief that the pandemic has transformed the debate over health care reform. Look at the vaccine rollout, said Comsti, the organizer. “It’s a beacon of hope that people will understand,” she added. “The Democrats that are in power right now understand that making sure that the government uses its power to rein in the pharmaceutical companies, to ensure that everybody has the vaccines that we need, and that it is free for everyone that that can happen. It’s not pie in the sky.”

The pandemic also makes it difficult to ignore the real villains in healthcare, Potter said, and the news is bad for the Partnership’s member groups. “I think people are waking up to the reality that even if you have insurance, it doesn’t mean that you can use it,” he explained. “We have not only more people who are uninsured, but vastly more people who are now underinsured.” Insurance companies are raising premiums, he continued, making it difficult for people to pick up prescriptions or see the doctor when they can’t cover their deductibles.

“It’s a situation in which I think more and more people with insurance are saying this just doesn’t work anymore,” he said. “Why do we have to put up with this? And hopefully we’ll be able to see that the public option is an offer that really should be available to people.”

The Fight Over the Public Option Is Already Here