Friday, January 13, 2012

Future of Public Option Update

Have liberals forgotten about the public option?

Supporters of health care reform are on the defensive these days; if Republicans sweep the 2012 elections, liberals will be hard-pressed to prevent a complete repeal of ACA. But what if Democrats win a solid victory in 2012, sending Barack Obama back to the White House, returning a Democratic majority to the House, and picking up a couple of seats in the Senate?  What would be the health care agenda then? Would the Democrats go back and finish what they had started by reviving and passing a public option on health care?

It’s still very early, but the first hints are a lot less promising than I would have expected for public option supporters. I checked the web sites of non-incumbent Democrats running for the Senate with decent chances of winning this year: those running in open seats and weak Republican seats in Nevada and Massachusetts. Of the seven candidates in six states that I looked at who had issue positions listed (a few still have only placeholder or minimal sites so far), none of them mentioned a public option.  None. Two mentioned drug reimportation; two didn’t mention health care at all.

The truth is that in the case of Democratic landslide, adding a public option would actually be quite possible – and a lot easier than it would have been back in 2009. That’s because unlike the full ACA back then, a public option would almost certainly be possible to include in a reconciliation bill, which would need only a simple majority in the Senate. On top of that, the public option (as liberals pointed out nonstop back then) has always polled extremely well. Granted, the Supreme Court decision could throw everything off-kilter, and there’s no guarantee at all that Democrats will win big in November. But if they do, it’s actually not that hard to pass – if it’s a campaign priority for those Democrats who win.

As I said, it’s very early, and most of these candidates have fairly slim issue sections on their web pages.  But of course that’s when it’s easiest to influence them. Hey, liberals! You want a public option on health insurance? Make it a mandatory position for Democrats running for Congress, and sooner or later the Dems will have a good year and they’ll pass it. Or, if you forget about it now, odds are it will never be passed.


  1. Tammy Baldwin is a for-sure public option supporter. She's gone on record in favor of single payer in the past.

    I'd be surprised if Murphy, Hirono, or Warren didn't favor it as well.

    1. Certainly true -- but there's a big difference between favoring it if pushed compared with highlighting the issue. Baldwin and Hirono don't have issue sections on their web sites yet (at least I didn't see any), so we'll see what they do in the future. Hirono is a really good test case (pardon the pun); she's in a classic liberal vs. moderate primary, and it will be very interesting to see whether that's an issue that she pushes to differentiate from her opponent, and if so how he reacts. My prediction has been that even moderates in contested primaries would wind up embracing it...but that's only going to happen if it's a visible agenda item, which in turn may only happen if liberal activists are pushing for it to be on the agenda.

      As I said, it's still very early, but I'll be watching this one all year.

  2. Good question.

    Mainly, it feel like everyone (Democrats and Republicans) is tired of fighting over health care reform.

    No matter how the Democrats do this year the Public Option won’t be be easier to add in 2013 than it would have been to include it in the first place in 2010.

    Right now the ACA isn’t that popular. It suffers from the long implementation period. It was passed ages ago and won’t really go into effect until until 2014. Now nobody really sees a difference and opponents can blame everything that’s wrong with health care in US on Obamacare.

    The strategy seems to be, hunker down, talk about something else, and try to implement the ACA as well as possible. Once there are insurance exchanges, guaranteed issue policies, tax breaks for purchasing policies etc... we can see how they work. Once they exist, people will realize they would rather these things weren’t taken away from them.

    And once there is an exchange we can revisit the question of whether that exchange should contain a national Public Option.

    I don't think it's now or never. It was 2010 or 2016.

  3. Swain's analysis seems solid.

    1. Agreed. The question won't come up again unless and until the ACA is fully implemented and it becomes clear that it leaves a gap that a public option could fill.

  4. I think folks are in limbo on this; waiting for the SC ruling on the law.

    I sort suspect the mandate, with it's fee for not obtaining health insurance, may -- over time -- morph into a public option.

  5. The public option will become more relevant as more employers opt to use freelancers and temps rather than employ full-time workers to avoid paying benefits. There are many families in which all workers are self-employed (mine included) and would like to see an option to buying private health insurance.

    I and my friends have post college age children and many of us have been thankful to the ACA for making it easier to get insurance for our children who are either unemployed, working in internships or as temps without health benefits.

    It's important that if we elect a democratic congress and president, that we not give up the fight for affordable health care. There is no guarantee that 2016 will be a democratic year.

  6. What about movement in the states? I understand several of them are trying to cobble together some sort of single-payer or public option with waivers from Washington. I can envision some sort of multi-state nonprofit compact that serves the same purpose without additional legislation ever passing congress.

  7. Here I was thinking it was the single most important legislative issue for the left since Taft-Hartley, or the Civil Rights Act of 1964. Failure to pass it has, as far as I can tell, turned the House over once, and will turn the Senate and White House over in the fal.

    I guess that's what comes from reading blogs.

  8. My impression is that, by and large, health care is just not a core issue for the activist left. It was big so long as the ACA was being pushed through the mill, but once something was passed it fell off the radar.

    Liberal activists seem more fired up by cultural issues (e.g. gender), broad-brush economic issues (e.g. stratification), and - for Obama critics - civil liberties and foreign policy (hence flirtation with Ron Paul).

  9. And since it was the most important legislative issue of 2009, and the left was betrayed on it by the Democratic Party, why do you think left-wing activists would trust any Democratic politician's promise on that or any other issue ever again? The public option betrayal broke the back of the Democratic Party. Just sayin'.

  10. I think Tom Allen is right, the public option fiasco so badly burned the activist arm of the party (rather, those base supporters who were actively working on issues) that it hasn't recovered yet, and I'm left wondering if it will recover at all.


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