Posted on Feb 21, 2022
The 1st public option health plan in the U.S. struggles to gain traction
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https://www.npr.org/sections/health-shots/2022/02/21/ [login to see] /the-first-public-option-health-plan-in-the-u-s-struggles-to-gain-traction
With prospects dim for the U.S. to adopt a single-payer "Medicare for All" program, health care reform advocates turned instead to an insurance plan designed by the government that could compete with private insurance plans sold on the health care exchanges. The idea behind this "public option" is that it could ultimately expand health care access by making a lower-cost plan available to consumers.
But the public option plan, though backed by Presidents Biden and Barack Obama, also has gone nowhere because of political opposition in Congress.
So some states have picked up the banner and are creating their own public option plans. But they, too, are facing formidable opposition from the health care establishment, which is resisting the pressure to reduce costs on the back end so that consumers can pay less.
Washington state, in its second year of offering the nation's first public option health insurance plan, has learned an important lesson: If you want hospitals to participate, you're probably going to have to force them.
With prospects dim for the U.S. to adopt a single-payer "Medicare for All" program, health care reform advocates turned instead to an insurance plan designed by the government that could compete with private insurance plans sold on the health care exchanges. The idea behind this "public option" is that it could ultimately expand health care access by making a lower-cost plan available to consumers.
But the public option plan, though backed by Presidents Biden and Barack Obama, also has gone nowhere because of political opposition in Congress.
So some states have picked up the banner and are creating their own public option plans. But they, too, are facing formidable opposition from the health care establishment, which is resisting the pressure to reduce costs on the back end so that consumers can pay less.
Washington state, in its second year of offering the nation's first public option health insurance plan, has learned an important lesson: If you want hospitals to participate, you're probably going to have to force them.
The 1st public option health plan in the U.S. struggles to gain traction
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PO1 William "Chip" Nagel
..."Washington state, in its second year of offering the nation's first public option health insurance plan, has learned an important lesson: If you want hospitals to participate, you're probably going to have to force them.
The Washington public option is more of a public-private partnership: The plan was designed by the state but is offered by private insurance companies. Anyone buying their own policy on the state's health insurance marketplace can sign up for a public option plan and, depending on their income, may receive significant subsidies from the federal government to lower its cost.
But two years in, the plans are available in only 25 of the state's 39 counties, enrollment numbers have been underwhelming, and state leaders blame hospitals.
"The plans had a hard time getting networks put together because the hospitals wouldn't play," said state Rep. Eileen Cody, the Washington legislator who introduced the public option bill in 2019. "They're a big part of the problem."
Officials from the Washington State Hospital Association said that more hospitals than not are voluntarily participating in public option plans. But, they noted, the public option relies on cutting payments to hospitals to control costs and ties reimbursement to Medicare rates, which don't cover hospitals' cost of providing care.
"If patients opt to join a public option plan rather than private insurance, over time it could create financial challenges, especially for small, rural providers operating on thin margins," said Chelene Whiteaker, senior vice president of government affairs for the hospital group.
Washington state legislators last year voted to mandate that hospitals contract with a public option plan if public option plans weren't available in each county in 2022. That mandate will go into effect for 2023."...
..."Washington state, in its second year of offering the nation's first public option health insurance plan, has learned an important lesson: If you want hospitals to participate, you're probably going to have to force them.
The Washington public option is more of a public-private partnership: The plan was designed by the state but is offered by private insurance companies. Anyone buying their own policy on the state's health insurance marketplace can sign up for a public option plan and, depending on their income, may receive significant subsidies from the federal government to lower its cost.
But two years in, the plans are available in only 25 of the state's 39 counties, enrollment numbers have been underwhelming, and state leaders blame hospitals.
"The plans had a hard time getting networks put together because the hospitals wouldn't play," said state Rep. Eileen Cody, the Washington legislator who introduced the public option bill in 2019. "They're a big part of the problem."
Officials from the Washington State Hospital Association said that more hospitals than not are voluntarily participating in public option plans. But, they noted, the public option relies on cutting payments to hospitals to control costs and ties reimbursement to Medicare rates, which don't cover hospitals' cost of providing care.
"If patients opt to join a public option plan rather than private insurance, over time it could create financial challenges, especially for small, rural providers operating on thin margins," said Chelene Whiteaker, senior vice president of government affairs for the hospital group.
Washington state legislators last year voted to mandate that hospitals contract with a public option plan if public option plans weren't available in each county in 2022. That mandate will go into effect for 2023."...
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