Minnesota has a Democratic Trifecta. It is a narrow trifecta, but it is a trifecta. It seems like the state government wants to do something about health policy and coverage.
— Zach Levin (@ZachLevinTweets) January 23, 2023
My question is what is the point and objective of a public option?
This is a key question. Emma Sandoe and I wrote a framework on how to evaluate Medicaid Buy-in programs in 2018 that I think is still relevant today:
The policy should be judged based on how the programs serve the policy maker’s intended goals. Medicaid buy-in proposals can achieve multiple goals. Each advocate may lay out their goals of this policy differently, but whether the details of their plan meet their stated goals can be determined using the criteria outlined in this post.
There are two different policies that can be described as Medicaid buy-in programs. The first would be creating a new eligibility category for direct purchase of Medicaid by individuals with all of the attendant rights, obligations, and services that flow through Medicaid. This version of Medicaid buy-in requires modifications to state plan amendments and likely will require an 1115 waiver. The other policy would be to use the framework of Medicaid managed care contracts and networks to create metal plans for purchase on the Marketplace. Policy makers must identify which type of Medicaid buy-in they intend to use to communicate clearly their goals and objectives.
What is the problem a public option is trying to solve?
The original Hacker public option was a competing insurance plan financed and organized by the government that would place massive amounts of competitive pressure on pricing and hopefully quality in the individual market. The pricing advantage would come from the government’s ability to administratively set prices at or near Medicare levels. This was scored as a major cost reducer by the Congressional Budget Office. It was killed by the Senate in 2009.
Since then, the public option as a concept has been amorphous. Washington and Colorado both have programs that they call a public option. In both cases, there is not a single public option but a plethora of privately offered and managed plans that have a bit more state regulation on them the other plans in the marketplaces.
Minnesota has expanded Medicaid. It, along with New York, runs a Basic Health Program (Section 1331) where individuals earning between 133% and 200% FPL are placed in a state run program instead of the ACA marketplaces. It has reinsurance for higher income affordability challenges.
I am trying to figure out how more choices helps with uninsurance and underinsurance. Adding a new plan that is likely to be priced fairly similarly to other plans in the market won’t do much if the problem is affordability. If the problem is complex navigation pathways to enroll then a public option is unlikely to be helpful.
What is the problem that is trying to be solved with another public option?