Public option fades with little outcry from progressives

The public option insurance plan has fallen off the national radar, despite being a major point of contention between moderates and progressives just a year ago during President Biden’s campaign.

But rather than holding Biden’s feet to the fire on the issue, progressives are concentrating on other health care priorities, like ensuring drug pricing reform and expanded Medicare are included in a massive infrastructure package.

“Crafting a public option is much more difficult than lowering the Medicare eligibility age and expanding benefits,” said Rep. Pramila Jayapal (D-Wash.), chairwoman of the Congressional Progressive Caucus.

“That’s where we are going to focus our attention at this moment. That doesn’t mean we’ve given up on the rest of the pieces. But I do think at this moment what we can immediately do is lower the Medicare eligibility age, add benefits and address prescription drug pricing,” Jayapal said.

Biden’s time in office has been consumed primarily with responding to the coronavirus pandemic, and the window to enact other parts of his ambitious agenda, like infrastructure, is now rapidly closing.

Outside advocates and Democrats say they haven’t given up on pursuing a government-run health care plan, but there’s an acknowledgement that a lot of legislative legwork is needed on that front.

Last month, Sen. Patty Murray (D-Wash.) and Rep. Frank Pallone Jr. (D-N.J.), who are in charge of health committees in their respective chambers, announced their intention to craft a public option bill.

Their process is just getting started, and there are numerous competing ideas on what a public option should look like at the national level. Pallone and Murray asked for feedback from key stakeholder groups, as well as the general public, on some of the most basic but thorny questions.

Frederick Isasi, executive director of the health care advocacy group Families USA, said that while a public option remains important, he wants to focus on items that might be able to pass quickly.

“The No. 1 question for us is what can we get done to move the ball forward? Our window for doing that congressionally is not very long. It’s a matter of a few more months to tee things up before we hit next year’s cycle,” Isasi said.

“The most important question is what is achievable, what is real, and significant? This is not the drawing board phase for the things that will be happening this year,” he added.

Rep. Jan Schakowsky (D-Ill.) said Democrats are largely focused on passing H.R. 3, the sweeping drug pricing bill backed by Democratic leadership.

“I think it’s definitely more a conversation about drug pricing right now than about a public option. The personnel decides, and the Speaker decides. If this is an immediate issue, it will be,” she told The Hill.

Former President Obama abandoned the public option when drafting the Affordable Care Act (ACA) in order to secure the needed votes from moderate Democrats, to the outrage of progressives.

Biden campaigned on creating a public option, touting it as a way to reduce costs without completely ending private insurance, in contrast to “Medicare for All.” The Medicare-like government insurance plan backed by Biden would be sold on ObamaCare’s marketplaces.

Biden said his proposal would cost $800 billion, as opposed to the estimated $32 trillion to enact Medicare for All.

But while the president’s $6 trillion budget unveiled last month expressed support for creating a public option, it was not included in the funding request.

“I think you have to, you have to choose your battles, and I don’t quibble with the fact that the administration made the decision to prioritize COVID relief and infrastructure. I think that’s probably the right way to go,” Sen. Chris Murphy (D-Conn.) told The Hill.

Murphy said without a push from the White House, it may be difficult to build momentum behind a public option, especially since most of the health care industry opposes any kind of government-run insurance plan.

Health care companies argue a public option would not reimburse providers enough, and would pull customers away from traditional insurance plans by offering cheaper premiums.

Still, Murphy said he thinks it would be easier to sell Americans on the benefits of a public option than it was to promote ObamaCare.

“The ACA was hard to understand. It was complicated. Worthwhile, but complicated. A public option — everybody should have the ability to buy a Medicare plan if they want. It’s really easy to message,” Murphy said.

Some progressives have never fully embraced a public option the way they did Medicare for All, because a public option would not abolish private insurance. Those lawmakers see expansions of health coverage as a stepping stone to Medicare for All.

House and Senate Democrats are currently eyeing a $6 trillion reconciliation proposal that would advance Biden’s infrastructure agenda and include lowering Medicare’s eligibility age to 60, broadening the program’s benefits to include vision, dental and hearing, and reducing the cost of prescription drugs.

“Most of the progressives believe that ultimately we should have a strengthened Medicare for All, and the steps that will get us there are the most important. And that’s why you see us prioritize the expansion of Medicare and the strengthening of Medicare,” said Rep. Ro Khanna (D-Calif.).

“Though we would vote for a public option,” Khanna added.