Would a public option have eliminated incentive for King v. Burwell?

By Big Tent Democrat, Section Supreme Court
Posted on Mon Feb 16, 2015 at 12:24:53 PM EST
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There is no public option in the Affordable Care Act. On its own merits, as Wendell Potter explains, that's a shame. But there is another reason why no public option in ACA is a bad thing - if ACA included a public option, the challenge to tax credits and subsidies on the exchange, now before the the Supreme Court in King v. Burwell, would never have existed.

The reason is obvious isn't it? Without the tax credits and subsidies, the public option would be the only affordable health insurance option for those persons who are mandated to purchase insurance because they do not have other insurance access (employment, veterans, etc.) the last thing Republicans want is for folks to migrate to public insurance options. Indeed, regarding Medicaid expansion, many red states have insisted on making Medicaid a private option affair.

It's worth considering whether Democrats should start arguing for adding a public option as the "fix" should the SCOTUS rule for the challengers in King. One of the reasons this works (and would have worked to forestall the King challenge) is that, in contrast to private insurance, which requires the government to transfer funds to it to cover the costs of private insurance purchased on the exchange (this is the "affordable" part of the ACA), a public option would not need a government transfer of money, since it is the government itself which would finance a public option. No tax credits or subsidies for the public option? No problem, it's just accounting entries anyway - from one government ledger to another.

It's time to consider the public option again.

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Would a public option have eliminated incentive for King v. Burwell? | 16 comments (16 topical)

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One problem is solved - sort of - (5.00 / 1) (#1)
by Anne on Mon Feb 16, 2015 at 01:20:41 PM EST

but how many are created in its place?

Actually, we can go all the way back to this question: isn't trying to build something "new" on the foundation of the private insurance model that brought us to this crisis in the first place the real problem?

And what, exactly is a "public option?" At some point, if you have to keep creating new, government-administered plans to capture everyone who's falling into the (widening and spreading) cracks between Medicaid and private insurance, wouldn't it make more sense to move toward a Medicare For All-type program? Because just as soon as you create a public option aimed at this latest group of potentially disenfranchised people, there will be a new group that doesn't fit into it - so either yet another new option will need to be created, or the existing one will need to be expanded.

One more thing: anything with the word "public" in it translates to more government spending, and we all know about those fights. I see about as much chance of a public option as I do me winning the next big lottery.

It really all comes back to the same place: we absolutely needed to reform the health industry, but counting on the private insurance industry to make it all work was not ever the right way to do it. And if we let this fail on what amounts to a scrivener's error, I think this whole thing could blow up, with dire economic consequences.

Yes all true (5.00 / 1) (#4)
by Big Tent Democrat on Mon Feb 16, 2015 at 01:28:26 PM EST

But I would argue what I propose is a step in the right direction, in most ways, BETTER than the original.


Maybe if Dems started making the case (5.00 / 3) (#5)
by Anne on Mon Feb 16, 2015 at 01:41:15 PM EST

for Medicare for All, it would eventually come down to "compromising" on the stop-gap public option, but I don't have a lot of confidence in that happening, what with the GOP in the majority and plenty of Dems in the pockets of the health industry.

Is it too much to hope that the prospect of blowing up the system and wreaking economic havoc on millions of people will be enough to sway the Supremes into ruling against the plaintiffs in this case?


: I think the public option goal (none / 0) (#6)
by Militarytracy on Mon Feb 16, 2015 at 04:05:59 PM EST

Is more probable to obtain. Anytime we are discussing dramatic change, for whatever reason that sort of change never even makes it out of the American debate gate.
It appears at this time that everyone wants coverage. "Obamacare" is popular more than it is unpopular. A public option puts a voting block together, it places working Americans and families on the same page instead of 50 different unity destroying pages. Once we are on the same page, it is easier to argue for and get improvements to the healthcare system that places us more in the company of 1st world affordable healthcare.

Different Analysis (5.00 / 1) (#13)
by ragebot on Tue Feb 17, 2015 at 01:40:33 PM EST

The suit is based on the wording of the law. State exchanges are defined as being set up by states and federal exchanges set up by the feds. Only state exchanges are defined as being able to give subsidies. The AG argues there is an implication that the federal exchanges are able to give subsidies, even if the wording of the law does not include those words. The AG also argues this was the intent of the law.

Historically the SC has taken the position that in cases like this the remedy is to have congress correct the wording in the law. Of course in this case it is unlikely the correction would pass the Senate and definitely would not pass the House.

Given the change in control of the House after Obamacare passed and later the change in the Senate in part due to the same reason I am not so sure any attempt to fix the law would pass until control of congress changes.

Glad you have this under control (none / 0) (#2)
by Jim in St Louis on Mon Feb 16, 2015 at 01:26:15 PM EST

"a public option would not need a government transfer of money, since it is the government itself which would finance a public option. "

fingers in ears
"la-la-la-la-la-La-La-LA-LA-LA!-LA!"

: It's the same money (5.00 / 1) (#3)
by Big Tent Democrat on Mon Feb 16, 2015 at 01:27:39 PM EST

My point is it doesnt require NEW money.

whose fault is this? (none / 0) (#7)
by thomas rogan on Mon Feb 16, 2015 at 08:13:27 PM EST

President Obama, House control, 59-41 Senate. You can blame this fiasco both on Obama and on Hillary, who proposed a similar plan when she had full control of congress in 1993-1994.

: What "fiasco"? (5.00 / 3) (#9)
by Yman on Mon Feb 16, 2015 at 08:53:08 PM EST

A legal challenge? To the ACA, which is the Republican plan of 1994?
Heh.
BTW - Do tell more about how Hillary had "full control of Congress in 1993-94."
Oy.

: Fiasco (5.00 / 1) (#16)
by CaptHowdy on Tue Feb 17, 2015 at 05:55:58 PM EST

fi·as·co
fēˈaskō/
noun
a thing that is a complete failure, especially in a ludicrous or humiliating way.
Interesting way to describe making good affordable health care available to millions who did not have it. Including me.
Not surprising but interesting.

: Since conservatives effectively controlled (none / 0) (#8)
by Molly Bloom on Mon Feb 16, 2015 at 08:38:15 PM EST

The senate, I guess we blame them. It's not always party affiliation, usually it's ideological affiliation. While all Republicans these days are conservative, there are usually some conservative Democratic senators to give the conservative faction control

Public option (none / 0) (#10)
by Abdul Abulbul Amir on Tue Feb 17, 2015 at 09:15:14 AM EST

Well paid administrators, second class service. Not really a problem for those completely deaf in one ear.

Yeah - let's judge ALL public options (5.00 / 1) (#11)
by Yman on Tue Feb 17, 2015 at 10:38:25 AM EST

... based on an article about hearing aids and the NHS, rather than looking at the larger picture, in which the NHS is ranked tops in efficiency and higher than the US, despite spending half of the amount per patient.

Oy.


Do you think that people who oppose (5.00 / 1) (#14)
by Anne on Tue Feb 17, 2015 at 02:42:03 PM EST

a public option always point to the problems in Canada or Switzerland because they don't want to acknowledge how well the public option we do have - Medicare - works?

I don't know of anyone who balks at the idea of saying goodbye to private insurance as soon as they qualify for Medicare; not that it's perfect, but it definitely works.

Why do people fear that so?


: No idea why (5.00 / 1) (#15)
by Yman on Tue Feb 17, 2015 at 03:18:02 PM EST

I think it's mostly a reflexive fear of what they perceive as socialism, etc.
Or maybe they just like they're own insurance and couldn't care less about others as long as they get what they want.

BTW - In the US, ... (5.00 / 2) (#12)
by Yman on Tue Feb 17, 2015 at 11:23:33 AM EST

... most insurance plans do not pay for any hearing aids which are (of course) far more expensive than they are in England. Only 19 states require coverage for hearing aids, and 16 of those only for children. Private insurance companies consider them to be "elective".

When private insurance does pay, it typically covers the cost of an exam to assess hearing loss, and that's about it.
The devices are expensive, sometimes costing in the $1,000 to $6,000 range -- and that's per ear. Perhaps this explains, at least in part, why 75% to 80% of adults with hearing loss do not get hearing aids ...

So if the NHS is offering "second class service". I guess our private insurance system is third or fourth class.

Now, ... do you really want to compare the "well paid administrators" of both systems?
