Congressional committee considering recommendations for implementing a ‘public-option’ health insurance system, while Biden administration works to improve the ACA
Sept. 3, 2021 (ACP) – Steady progress is being made in improving access to health care. Congressional committees are discussing what needs to be part of a “public-option” health insurance system, and the Biden administration is proposing a series of beneficial improvements to the coverage provisions of the Affordable Care Act.
“ACP members benefit when their patients are enrolled in affordable, comprehensive health coverage,” said Ryan Crowley, ACP senior associate of health policy. “That's why we're working so hard to support sensible federal efforts to expand access to coverage. We're making sure that our voice is heard at every step of the process.”
According to Crowley, health care access is getting attention now for several reasons. “The COVID-19 pandemic has raised the importance of having good coverage. The new administration wants to expand coverage and reverse some of the previous administration's health care policy changes,” he said. “Also, the Democrats know they only have a brief window of opportunity to make big changes before the next election, so that adds to the sense of urgency. There's also a need to hold down health care costs since health insurance premiums are rising and more people are underinsured.”
Last spring, the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor & Pensions asked for information about how a federally administered public-option insurance system should be designed. Like Medicare, this kind of insurance plan would be run by the government.
“ACP believes that the U.S. health care system requires an overhaul and envisions a health care system where everyone has coverage for and access to the care they need, at a cost they and the country can afford,” said Dr. George M. Abraham, president of ACP, in a July 22 letter to committee leaders. “ACP strongly recommends transitioning to a system of universal coverage through either a single-payer system or a public insurance plan to be offered along with regulated private insurance.”
Specifically, “ACP supports the idea of a public option because it expands choice and provides a good coverage option available nationwide,” Crowley said.
In the 20-page letter, ACP lays out a series of recommendations for the design of a public-option insurance program. Among other things, it says coverage should be broadly available, physician participation should be voluntary (as is the case with the Medicare and Medicaid programs) and investment in primary care should be increased.
ACP adds that payments under federal programs are too low and should not be the foundation of a public option. “Current Medicare payment rates generally are insufficient to achieve the objectives of universal coverage,” the letter says. “Similarly, Medicaid rates are often lower than Medicare's and inadequate to attract physician participation.”
As Crowley put it, “physicians are more likely to participate in a health plan that offers high-quality service to patients, limits administrative burdens for physicians, and provides fair and sufficient reimbursement rates.”
In addition, ACP believes that cost sharing for high-value care should be eliminated.
Despite all the action in Congress, the prospects for a public option may be limited, Crowley acknowledged. “The public option is politically controversial. It's unlikely to get bipartisan support, which will make it difficult to push through Congress,” he said. “It's also very complicated since the government would be developing a coverage program from scratch.”
Meanwhile, the Biden administration has released its first major proposed rule to reform the Affordable Care Act health insurance exchanges. “The proposal would reverse some of the previous administration's initiatives to promote health plans that don't comply with the ACA,” Crowley said. “It would also expand the health insurance exchange open-enrollment period to give people more time to shop for coverage.”
ACP supports several of the proposed changes and appreciates the effort to ban insurance plans that do not comply with the law, Crowley said. “ACP also supports the improvements to the Navigator program so navigators can help familiarize patients with their health coverage,” he said.