I am thrilled that the House passed its public option plan last week. It's going to be the beginning of a new era in the United States. Sadly, there have been some incorrect statements made about the public option plan by ill-informed writers. The purpose of my post is to give facts, and only facts about the public option.
The goal of health care reform is to provide quality, affordable health care for every American while preserving what works in today’s system, expanding choice, and containing costs. The Affordable Health Care for America Act creates a public health insurance option that would compete on a level playing field with private insurers within the Health Insurance Exchange. In the first years, the Health Insurance Exchange is targeted to serve employees of small businesses, the self-employed and the uninsured. The public option will not be limited to just a few Americans; it will be available for purchase, from day one, by all Americans that are uninsured, self-employed, or work for a small employer with less than 26 employees. The second year, the uninsured and self-employed will still be able to buy the public option but it will also be extended to even larger small employers, including those with less than 51 employees. By the third year, small employers with less than 101 employees will be folded in. The only place the public option will be available is in the 'Exchange.' These are the facts, as presented in the bill passed by the House:
- Today, many areas of the country are dominated by only one or two insurance companies. establishing a public health insurance option will create a new choice for individuals and families.
- Competition in consolidated markets, driven by the introduction of a more efficient and transparent plan, will help lower premiums for all plans as the private market is forced to compete on a level playing field for the first time.
- By creating an alternative in the market, both public and private plans will be accountable for their actions because people can leave one for the other during enrollment periods. For example, if the public option fails to maintain an adequate provider network, people will not enroll. Likewise, if the private plans
inappropriately restrict access to care, people may choose the public option.
- The 'public option' plan is not free. It is purchased by paying premiums. Any American that wants to have his or her insurance provided by the public option plan will have to pay premiums to the plan.
- The public health insurance option must meet the same benefit requirements and comply with the same
insurance market reforms as private plans.
- Like private plans, premiums for the public health insurance option will be established for the local market areas that are designated by the Exchange and will vary by region.
- Individuals in the Exchange can choose freely among the private carriers and the public option. Employers who participate in the Exchange cannot dictate employees’ participation in a particular plan.
- Some Americans may receive subsidies (called 'affordability credits') if their income levels are close to the poverty line. Affordability credits can be used for any plan in the Exchange — public or private.
- To ensure independence of the Exchange, the public health insurance option will be run by the Department of Health and Human Services, not the Exchange.
- Like private plans, the public health insurance option must be financially self-sustaining and maintain its
operations using premium revenue.
- The public health insurance option will have lower administrative costs than private plans, and it will be
accountable to its enrollees and taxpayers, not shareholders or highly-paid executives.
- The Secretary of Health and Human Services will negotiate provider payment rates, which can be no higher than the average private plan rates and no lower than Medicare.
- All Americans who are without insurance, who are self-employed or are employees in small businesses with less than 101 employees will be allowed to purchase the public option plan.
Anyone wanting facts rather than myths should go straight to the House of Representatives and to the bill itself. For more information about the public option, please consult this page: Affordable Health Care for America Act.