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Public health workers, doctors, and nurses protest outside a hospital in the Bronx on April 17, 2020 in New York. (Photo: Giles Clarke/Getty Images)

This Is How We Win on Affordable Health Care Now

A "public option" for health insurance is broadly popular with Americans.

Laura Packard

Joe Biden promised me at the Democratic National Convention that he would work towards a national health insurance public option. My Senator, Michael Bennet, put forward a national public option plan, called Medicare-X earlier this year. A limited version of the public option is re-emerging in the Build Back Better bill to fix the so-called Medicaid gap, which traps low income people in conservative states (Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming) without health care. Reforms in progressive states like Washington, Nevada and Colorado are leading the way.

We can do this by pushing forward a national public option to cover the Medicaid gap now, and more robust state-based public options next year, while building towards health care for all.

I was diagnosed with stage 4 cancer in Nevada in 2017, and went through treatment while on an Affordable Care Act health insurance policy on the state exchange. I am grateful for the coverage I needed to pay for hundreds of thousands of dollars of chemo and radiation treatments. However I still had to pay tens of thousands of dollars out of pocket for my care, even with the ACA. Moving to Colorado in 2019, I've had to pay thousands of dollars for care in Denver too—just for checkups and lab tests.

The cost of health care in America is too high. People support making health care more available and affordable, while the health care industry fights tooth and nail to preserve profits and keep things the way they are. States like Nevada and Colorado are showing a new way forward.

At the beginning of 2021, Colorado, Connecticut, Nevada and Oregon state legislatures proposed state-based alternative health insurance options to support competition in the insurance industry. A "public option" for health insurance is broadly popular with Americans. The state of Washington led the way, passing the first public option in 2019, and other states have followed.

The bills so far are not true public options, in the sense that they are not publicly owned and delivered insurance plans a la traditional Medicare or Medicaid. Instead, they are a public-private partnership: heavily regulated and price controlled plans offered by private insurers. With rate-setting—controlling the amount that the plans pay for services, the state-based health insurance options are one of the few methods to reduce the out-of-control costs of our health care.

In Colorado, a bill was publicly released in March, which then unleashed record amounts of spending by opposing forces. Players in the health care industry including insurers and hospitals fought the Colorado option until it was watered down enough to get most opponents to a neutral position. After months of attacks, the compromise bill was signed into law the summer.

Advocates in Nevada learned from this. They followed a quieter method, releasing a bill towards the end of session in April to give opponents less time to spin up multi-million dollar ad campaigns and lobbying efforts. The bill did get negotiated down, but it was signed into law more intact than in Colorado.

After threats by big insurers in Connecticut, the Governor came out against a public option, and the legislation died for the third year in a row this spring.

However, the Oregon legislature passed a bill to create a study on the public option, and may look at passing a full plan next spring. Other states may follow.

In order to lower the cost paid by patients, cuts need to come from somewhere. Every group from doctors, to hospitals, to insurance providers, to pharmaceutical manufacturers will fight to make sure it doesn't come from their profits. But industry voices are often prioritized by elected officials over the people that they are purportedly serving.

As activists, we can win these fights, but it's easier on a state level to counteract the money and misinformation with real people's stories. It also can be easier to take on the fights piecemeal, by tackling a smaller segment of the market (such as individual insurance plans rather than employer plans, or focusing only on people without insurance in limited states due to the Medicaid gap), rather than the entire system at once.

Through nearly a century of attempts and failures, President Obama and a Democratic Congress finally passed health care reform through the Affordable Care Act, and the Supreme Court upheld it for a third time this spring. The ACA was not a perfect solution, but it was a framework that helped millions of people get access to health insurance. Including small business owners and self-employed people like me. Now we need to build on it.

Millions of low income Americans in states like Florida, Georgia, North Carolina and Texas have been priced out of insurance because Republican legislators in their states chose not to expand Medicaid under the Affordable Care Act. Senators Warnock, Ossoff and Baldwin have released a new plan for a national Medicaid-like public insurance option to cover low income people in non-expansion states with health insurance. A version of a national fix to this problem is so far included in the Build Back Better budget reconciliation bill. But the health care industry is already pushing back.

Our work is not done until every American can afford the health care they need. While increasing accessibility, we also need to keep chipping away at the inflated prices of care in every part of our medical system. We can do this by pushing forward a national public option to cover the Medicaid gap now, and more robust state-based public options next year, while building towards health care for all.


Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.
Laura Packard

Laura Packard

Laura Packard is a Denver-based health care advocate and founder of Health Care Voices, a non-profit grassroots organization for adults with serious medical conditions, senior advisor to Be a Hero and co-chair of Health Care Voter.

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