By H. Harrison Coleman IV
President Biden’s campaign promises and the legislation that would oversee them, after a lengthy period on the legislative back burner, seem to be unfurling after a long and arduous impeachment trial and 57-43 failed conviction of former President Donald Trump. The legislation in question is Biden’s goal of establishing a public option in US healthcare insurance.
The public option is a proposal that would create a publicly-run health insurance plan that would compete with private insurers, offering US citizens the option to purchase a healthcare plan that is not tied to their jobs or region.
The idea of a public option is not a new one, as President Obama in 2009 attempted to add a public option to the Affordable Care Act, but it was voted out of the final bill in a Senate committee. The public healthcare option was generally considered radical until recently—the Democratic Party only added it to their platform in 2016 for former Secretary of State Hillary Clinton’s presidential run. The Republican Party, on the other hand, has criticized the public option idea as being too reliant on the government.
Ever since Senator Bernie Sanders’ (I-VT) 2016 presidential bid, another healthcare plan has gained popularity: Medicare For All. Medicare For All is a plan for the federal government to create a single-payer healthcare system wherein the government takes total control of healthcare in the United States (although some proposals would allow some private insurers to exist) and allows all citizens access to free healthcare (eliminating current premiums and other out-of-pocket costs) paid for through taxes.
In comparison to the Progressive- and Socialist-backed Medicare for All plan, the public option—wherein the government would act only as another healthcare provider as opposed to taking total control—has been lauded as a compromise between Medicare For All and the current situation.
In his run for the Democratic nomination and the presidency President Joe Biden ran on a platform that featured a public option in US healthcare. With a majority (albeit a slim one) in the Senate and maintaining in the House of Representatives, Democratic senators Michael Bennett (D-CO) and Tim Kaine (D-VA) have introduced legislation to create a public option: the Medicare X Act.
The Medicare X Act has been introduced many times since President Obama’s failed attempt to pass it as a part of the Affordable Care Act, but this version is unique; the 2021 edition has been altered to reflect Biden’s campaign promises more accurately. For instance, this version of the bill limits premiums under Medicare X (which is the current name of the public option proposed) to 8.5% of a person’s income. Because of the slim Democratic majority in the Senate, the 2021 bill has been designed to pass through budget reconciliation—a long and drawn-out process of getting a bill passed in the Senate with only a majority vote, as opposed to the typical 60-vote requirement that is imposed by the Senate’s filibuster. Budget reconciliation can only be used once a year, but because the preceding Congress did not use 2020’s reconciliation, the current session of Congress is allowed three (2020’s + 2021’s + 2022’s). With the $1.9 trillion stimulus package (American Rescue Plan Act) being passed using reconciliation, the Democrats can use the process to pass Medicare X and would still have one use of reconciliation left to use for this session of Congress (possibilities include passing a hinted-at infrastructure package, or repealing the 2017 tax reform bill passed under President Trump, which was also passed via reconciliation).
Proponents of the public option say that because private insurers would be made to compete with a government-run option, they would be forced to lower their prices, resulting in cheaper healthcare all around. They also say that because of the lowered premiums for many Americans, the government will actually save money by avoiding paying for subsidies. Additionally, they claim that the public option would cover more of the poorest Americans who would not otherwise be able to afford health insurance.
On the other hand, opponents claim that the competition between the public option and private plans would be unfair because while the private insurers are only singular corporations, the public option would have the full backing of the US government. They also point to government-run healthcare’s ugly history in the US, from the forced sterilizations that targeted minorities in the 20th century to the infamous Tuskegee experiment.
There is no sure outcome of this new push for a public option. In the 50-50 divided Senate, the Democrats hold the majority by a razor’s edge, and any hope for the implementation of this policy rests on whether all 50 Democrats (plus tie-breaker Vice President Kamala Harris) can agree on what exactly they want.