Report: Public Plan Choice In Congressional Health Plans

The Good, The Not-So-Good, And The Ugly

By Jacob S. Hacker, Ph.D.

EXECUTIVE SUMMARY

The historic health reform bills passed out of three House committees and the Senate Health, Education, Labor, and Pensions committee all include a national public health insurance plan as a way to rein in costs, improve quality, and help make health care affordable. This new public plan would be available alongside regulated private plans within an insurance “exchange” open to those without employment-based insurance, promoting choice and competition in often highly concentrated local insurance markets. Yet crucial differences in the design and robustness of the public plan distinguish the bills passed out of committee. Meanwhile, the Senate Finance Committee, which has yet to produce a bill, has already taken the public health insurance option off the table.

This policy brief explores the various versions of public plan choice on the congressional agenda and shows how their best aspects can be combined to produce an effective public plan that will deliver on its promise—and why the cooperative “alternative” embraced by negotiators in the Senate Finance Committee does not merit consideration.