Senate Democrats unveil health care proposal with public option

Two Democratic senators released their version of a public option health care plan Wednesday, setting the stage for this year’s debate over how best to expand coverage to the millions of people who are uninsured.

The proposal from Sens. Michael Bennet (Colo.) and Tim Kaine (Va.) would create a government-run health care plan on the Affordable Care Act (ACA) exchanges to compete with plans offered by private insurers with the hope of driving down costs. 

Democrats’ razor-thin majority in the Senate could complicate any major health care reform, though Kaine said he will push for the proposal to be passed via reconciliation, which avoids the filibuster and requires only 51 votes 

The upper chamber is split 50-50 between the two parties, with Vice President Harris serving as a tie-breaker. 

That means that with no GOP converts, every single Democrat would need to get on board with the plan, which Kaine and Bennet argue is closest to what President Biden ran on. 

“I think we are in the spot where Joe Biden was during the campaign, and that suggests to me that this could be a consensus position for Democrats going forward,” Bennet told reporters Wednesday.

Biden endorsed a similar plan while running for president, pitting himself against Democratic candidates such as Sen. Bernie Sanders (I-Vt.) who favored a single-payer approach that would reshape the entire health care system so everyone gets coverage through the government.

A public option is seen as more feasible politically in that it would compete with but not replace private plans while still reducing the number of Americans without health insurance. 

Still, any proposal that expands the government’s involvement in the health insurance markets is typically opposed fiercely by the industry and most Republicans.

The Bennet-Kaine plan would mirror the framework of Medicare, the federal health insurance program for the elderly, but with additional benefits for younger populations. 

Similar bills have been introduced in previous years, but under the new version, the public option plan would cover primary care services without cost-sharing requirements such as co-pays or deductibles. 

The plan would initially be available in areas where there is a shortage of insurers on the individual market or higher premiums due to less competition, particularly in rural communities. About 10 percent of counties have only one insurer offering plans on the ObamaCare exchanges in 2021, according to the senators. 

The public option would be available to all parts of the country by 2025. 

The proposal would also boost subsidies that help people buy health insurance on the individual market and expand eligibility to more income levels. It would also fix a “glitch” in the ACA that prohibited family members of people insured on the exchanges from receiving a tax credit, potentially expanding coverage to up to 6 million more Americans, according to the senators. 

Health care providers such as hospitals and doctors that participate in the traditional Medicare program would be required to accept patients covered by the public option and would be paid similar rates for their services.

Providers in rural areas where access to health care is lacking might be eligible for higher reimbursement rates.

The proposal would also allow the federal government to negotiate with drug companies for lower prices of drugs covered by Medicare, something that is currently not allowed under federal law. 

The plan and others like it are likely to face pushback from the powerful health industry, which spends millions of dollars every year lobbying Congress and donating to political campaigns.

A public option was part of original versions of the ACA but was derailed by moderate Democrats and pressure from the health industry. 

More than a decade later, the public option is typically viewed as one of the more moderate proposals to expand health care coverage, with single-payer being endorsed by the more progressive members of the Democratic caucus.

Bennet indicated his proposal would be easier for his colleagues to vote for.

“This is not something that can be brought down by the ideological talking points that have been used to attack other proposals, that over the years have been demonized incorrectly by opponents of universal health care,” he said.

“I think this plan is one that is going to be very popular with the American people and one these people are going to want to vote for.”