Public Programs in Health Insurance Reform

Chris Bowers has a useful post pointing out that even though there’s no public option per se in the health insurance reform bill, supporters of public sector health insurance and public sector health care did win important gains, including an expansion of Medicaid to cover 15 million more people than current law and massive new investments in community health centers.

And from Bowers’ longer list of ways progressive strengthened health reform legislation I would especially point to the inclusion of the rule that exchange plans maintain an 85 percent medical loss ratio. This could have been bumped even higher, but the CBO said that if it was bumped higher they would start scoring it differently. In the particular context of this bill, that was a major impediment. But I actually don’t think it’ll be a significant barrier if some future congress wants to consider a 90 or 95 percent medical loss ratio, which would in effect turn all the exchange plans into public options of a sort.

Probably the 112th and 113th Congresses will be sick of health care, but that particular provision is an area where I’m optimistic that future progressive organizing can be very effective. The only impediment to going further in the 111th Congress was a quirk of CBO rules that wouldn’t carry much weight were the medical loss ratio issue being considered on a stand-alone basis.