Democrats use the public option for a test drive.
The proposal for a new public insurance plan is enjoying its first signs of life this Congress: Senate Health Committee Chairman Patty Murray and House Health Committee Chairman Frank Pallone sent a letter to lawmakers, policy experts, patient advocates and the healthcare industry on Wednesday ask for input on the public option laws they want to draft.
The letter alone doesn't do much. After the public option was banned from major White House Biden policy proposals and reportedly removed from the President's budget, this is the first indication that Democrats are still taking the idea seriously.
If Democrats write a bill and try to get it going through the House and / or Senate, it would be the first real test in more than a decade of how a public option would stand up to political scrutiny.
Republicans struggling to find an effective message to stand up against President Joe Biden would likely take the chance to blame Democrats for having the government take over health care for the people, as it is in the campaign against that Act on Affordable Care before their achievements were done in the medium term 2010. The industry is already speaking out aggressively against the expansion of the state health system.
But the Democrats are moving forward in part because they believe health care policies have changed since the ACA debate when the public option was sunk because it did not have enough support despite the party's 60-seat super-majority in the Senate.
The ACA survived the Republicans' repeal attempts in 2017 and is now quite popular with the American public. The public option also fits well with voters, and is supported by more than two-thirds of adults in the United States in a recent poll by the Kaiser Family Foundation. Almost half of Republicans said they supported this. Democrats believe rejecting a public option could be a difficult vote for some of their counterparts across the aisle.
But opinions are not yet hardened and people could still be convincing. Political ideas can appear more popular in the abstract before they turn into prominent, polarized struggles. The evidence that positive or negative news can materially affect support for or against Medicare-for-all is a telling example.
Defining a public option as more choice can be effective with some independents and Republicans, say scholars who tested public opinion on the subject. But does this effect persist if there is a campaign for Republicans and corporations portraying politics as socialism? Or has the ACA's rehabilitation, which Democrats believe has been driven by major political achievements, undermined the effectiveness of such a message?
This big political question could determine the fate of any future proposal to expand public health care. We would get an idea of the answer if the Democrats manage to come up with a public draft option for this Congress.
This is also a chance for Democrats to embark on a particular plan. As Sarah Kliff and I have reported, there are several proposals in Washington for "public options." Some would be intentionally restricted to selected populations; others would be more expansive, with the longer-term goal of enrolling as many Americans as possible.
The Pallone-Murray letter asks for feedback on a number of key policy questions: Who should be eligible for the public option? How Much Should Vendors Pay? What benefits should the plan offer?
Expectations should be tempered as to whether the public option is going anywhere anytime soon. Democrats are playing it slow, and the proposal is so far excluded from their plans for a “budgetary vote” bill that could be passed without a Republican Senate vote. It may not match the rules that limit what policies can be passed through the voting process. It would also take almost unanimous support among Democrats to pass, given their small majority in the House and Senate. It's easy to imagine that a public option law could just get past the house but not clear the Senate.
Still, this move by Pallone and Murray is remarkable: two of the top Democrats working in the healthcare sector are giving the public option a chance.