As the United States rebuilds from this pandemic, we must aim higher than a return to the status quo — we have an opportunity to lower health care costs and expand options for millions of Americans, giving them more choices with a public health insurance option.
A public option is a simple idea: a health insurance plan offered by the federal government in all Affordable Care Act marketplaces. It would guarantee good-quality coverage with competitive premiums to help drive down costs in the health care system.
When we and others in Congress began the fight for a public option more than a decade ago, 20 million fewer Americans had health insurance. People had no guarantee of coverage for preexisting conditions. Those with terrible diagnoses faced insurers’ lifetime caps on the care they would cover that punished with financial ruin the crime of getting sick.
The Affordable Care Act fixed those problems and many, many more. We are proud of our votes for that legislation and the care it provides. But at the time, we worked to go even further, promoting a public health insurance option for all Americans. We wish that had been included in the bill.
But as the Covid-19 crisis has made brutally clear, it is past time for a quality, low-cost public option in every health care market in the nation.
The pandemic exposed tragic gaps in our health care system, especially the lack of quality, accessible, affordable insurance coverage. Many people on the frontlines of the crisis — grocery store clerks, farm workers, Amazon delivery drivers, and so many others — had no health insurance through their employers. Many suffered crushing illness from the coronavirus only to suffer crushing financial distress in its wake.
Although the full economic effect of the pandemic on frontline workers without insurance is not yet clear, this much is known: In restaurants, 1 in 5 servers and 1 in 4 cooks has no health insurance. Among construction workers, it is 1 in 4. For farm workers, every other person doesn’t have health insurance. About 1 in 7 meatpacking workers are uninsured, working in hundreds of meat and poultry facilities across the country that reported Covid-19 outbreaks. Reports emerged last week of a pork processing plant where nearly half of the employees have contracted the virus. Workers lose wages from days out sick, and trips to the hospital can accrue massive bills. One analysis of 30 billion private health care claims showed the average out-of-pocket cost for an uninsured Covid-19 patient’s hospital stay tops $73,000.
There is some good news in the American Rescue Plan for low-income, uninsured, and laid-off Americans grappling with the cost of Covid-19 are. Democrats included help through COBRA subsidies for Americans who lost their jobs, expanded Affordable Care Act marketplace subsidies to those who previously didn’t qualify for them, and boosted the Advance Premium Tax Credit to lower out-of-pocket medical costs for millions of people. As a result, many Americans will see dramatic drops in their health insurance costs. For example, the Congressional Budget Office projects that a 64-year-old making $58,000 per year would see their premiums fall from $1,075 to $412 under the American Rescue Plan subsidies.
But even with all this help, a nationwide public option is the best next step toward lower-cost, high-quality health coverage with no gaps or costly surprises. And it’s broadly popular: 68% support a public option, including 56% of Republicans.
The Covid-19 crisis brings the public option closer to reality than it’s been in a decade. While those at the top of the income ladder have done fine during the pandemic, unemployment snatched away employer-based health care coverage from far too many American families. For those uninsured workers who risked their health and the health of their families to keep our economy going, the fundamental unfairness of the current system is obvious. This is why Americans’ top health care priority for our new president is lowering their monthly premiums.
The Consumer Health Options and Insurance Competition Enhancement (CHOICE) Act, which we introduced in the U.S. Senate, would accomplish that goal. This bill would create a public option on Affordable Care Act exchanges, and would offer the same premium tax credits and cost-sharing reductions for consumers as other exchange plans. This would inject more competition into marketplaces, giving more choices to Americans when they shop for health insurance coverage and helping to keep costs down.
The fight for a strong public option bill has been long. We pushed hard for its inclusion in the original Affordable Care Act, and we offered iterations of the CHOICE Act in Republican-controlled Senates — but their goal was to repeal the ACA and return to the pre-Obamacare dark ages.
Today, the public option faces Democratic majorities in both houses of Congress and, if passed, would land on a Democratic president’s desk. Ours isn’t the only public option plan being developed in Congress; we plan to work with the supporters of those proposals to arrive at consensus legislation that can draw wide support.
Dark times are often a catalyst for great progress. Americans have for too long paid too much for a health care system that too many cannot access. It’s time to seize this moment and finally pass this expansion of coverage into law.
Sheldon Whitehouse, a Democrat, represents the state of Rhode Island in the U.S. Senate. Sherrod Brown, a Democrat, represents Ohio in the U.S. Senate.