In our opinion: the future will tell us about public health insurance
Washington’s public option health plan demonstrates the complexity of U.S. health care, which often serves patients and providers poorly. Lawmakers must continue to assess the country’s premier system to ensure it works as promised.
In 2019, the legislature approved a plan for the state to contract with private insurers and offer insurance plans under specific guidelines with cost limitations. The idea was to make health insurance accessible as Republicans in Congress tried to overturn the federal affordable care law without a plan to replace it.
Unlike various proposals promoting medicare for all, Washington’s system does not eliminate private insurance. It creates a public-private partnership designed to make insurance affordable and available to those who otherwise would not have coverage. For example, it protects coverage for people with pre-existing conditions, which Republicans have spent years seeking to reverse.
But as Washington’s plan takes root, a public option is only available in 19 of the state’s 39 counties, according to a Crosscut report. Clark County is one of the regions without a public options provider. And by May, fewer than 2,000 Washington residents had signed up for the system.
“It’s starting to take hold,” Michael Marchand of the State Health Benefit Exchange told Crosscut. “It just takes a while… for the new products to take hold. “
State Senator David Frockt, D-Seattle, who was the plan’s main legislative sponsor, said, “It’s still early days. We’re always on the cutting edge of technology, if we can make it work.
For this to work, more hospitals will need to be drawn into the system. Insurers offering public option plans are limited to paying hospitals and providers 160 percent of what is paid for by Medicare. This limit is calculated across a network, which means that some providers may get paid more if others get paid less.
State Representative Eileen Cody, D-West Seattle, said the legislature may have to revisit this “soft cap” in the future if the public option does not deliver the savings lawmakers expect.
Confusing? Welcome to the American health care system.
Nationally, more than 30 million Americans have purchased health insurance through exchanges offered by the Affordable Care Act. But nearly 50 percent of the population is insured by employer-provided plans, and surveys show that most consumers are happy with their coverage. For this reason, a health care overhaul is a political no-start, despite support for Medicare for All by some Democratic leaders.
Washington’s public option system was designed to fill the gap for those who lack employer-provided care and cannot afford individual insurance. Lawmakers in Nevada and Colorado have since passed similar systems that are not yet operational, and Senator Patty Murray is working on a public option system at the federal level. They can learn from Washington’s experience, even as the state struggles to fine-tune its system.
For now, the immediate concern is to encourage a public option in the 20 counties where it is not available. This includes in particular counties with high and low populations.
Frockt said: “This is the first time that we are trying to do this in the country. We really didn’t know how it was going to play out.
In the process, lawmakers may have done nothing more than add to the confusion of American health care.