By Emma Watson

Former South Bend, Ind., Mayor Pete Buttigieg made the increasingly popular “Medicare For All” plan his own during his recently ended presidential campaign by offering it to “all who want it.” 

Simply put, a public option plan is a midpoint between our more moderate status quo, where Americans have a huge range of public and private payors, and the more leftist proposals that Senators Warren and Sanders have offered up. Proponents of the Public Option, like Buttigieg, advocate for a compromise; they seek to expand government-run programs to allow more Americans to access insurance coverage through a public system, but they do not want to “force” them into the plan. The Public Option would allow middle-income adults who are old enough to vote but too young to receive Medicare the ability to buy into a government-run insurance system instead of a private or employer-sponsored plan. There are various ways to manage a system of this type, but the dominant proposals are to enable consumers to buy into existing plans (such as Medicare or Medicaid) or empower the government to create an entirely new insurance plan specifically for this population and their dependents. 

There have been modern attempts towards moving the U.S. toward a Public Option system. The most popular of these efforts was led by Michigan Senator Debbie Stabenow, who brought her bill to the Senate floor in February 2019. In this bill, Stabenow proposed lowering the age requirement for Medicare from 65 to 50. She hoped that this more centrist legislation would be a feasible plan to insure Americans and appeal to her more conservative colleagues. Unfortunately for the nearly 60 million Americans aged 50-64, Senator Stabenow’s bill never made it out of committee. 

Buttigieg hoped that “Medicare For All Who Want It”, which would build off the ACA, was America’s path toward high-quality healthcare that is more affordable for everyone. And he contended that he was the only progressive presidential candidate to offer a system that promoted both access and autonomy. The implementation of his “Medicare for All Who Want It” would allow people to maintain their private insurance plan, should that be their preference, or to opt into a public payor like Medicare. More specifically, the policy will automatically enroll individuals in public coverage if they are eligible for it (considering citizenship, income requirements, and other criteria established by Congress), subsidize others, and allow everyone else the choice of paying for coverage under the plan. The mayor explained that his administration would fund the $1.5 trillion 10-year-plan by rolling back President Trump’s tax cuts and negotiating pharmaceutical prices. 

Buttigieg’s main policy had a few substantive accouterments:

  • He addressed premium expenses. He elaborated that his administration would ensure that no American family will spend more than 8.5% of its annual income on their insurance plan, whether it be private or public. To deliver this, he would provide subsidies to all applicants. 
  • Buttigieg’s plan would cap out-of-pocket expenses for Medicare as it exists now. As it is, there is not a cap; this would limit the financial risk seniors face when accessing healthcare. 
  • He would end surprise billing. Right now Americans face predicaments associated with out-of-network services and providers at in-network facilities. Buttigieg’s plan would bill all services provided as in-network if the facility is.
  • He would cap the fees insurers can bill patients for out-of-network care to twice Medicare’s rates. This, he boasted, would lower premium costs. 

There are some clear benefits and some obvious drawbacks to this plan. Buttigieg contributed some interesting ideas to the conversation, but like Elizabeth Warren suggested in a recent debate, his ideas may not have the specificity required to convince longstanding legislators. His plan, though, seemed to provide uniquely more choice than some of his competitors’ and would have allowed private plans to continue as they were. However, this in itself, may have some drawbacks, because it would not ameliorate the issues associated with the paperwork and administrative work required to manage so many payors. He also argued that over time this would force private insurers to drive down their rates to maintain competition with a newly robust public payor system.

Healthcare Legislative Lexicon: 

  • Medicare – a publicly-funded and government-run healthcare system, servicing those 65+, with a chronic disability, and with End Stage Renal Failure 
  • Medicaid – a publicly-funded and government-run healthcare system, servicing low-income individuals and families 
  • Out of network –  a service provider (hospital, physician, ambulance) that does not have a contract with your health insurance provider 
  • Payor – any legal entity responsible for handling claims for health care services under a state or federal medical assistance program
  • Premiums – an upfront payment made on behalf of an individual or family in order to keep their health insurance policy active
  • Surprise billing – this happens when a consumer receives care from an out-of-network provider in a situation she cannot reasonably control, such as being treated by an out-of-network anesthesiologist at an in-network hospital.
  • Universal coverage – all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need

Emma Watson is in her first year as an MPA-Health student at NYU Wagner. Emma’s area of interest is where social justice intersects public health, and she plans to leverage writing and communication to shape policy, inform communities, and help minority groups advocate for themselves. Her policy and advocacy skills have been leveraged through her roles at Deeds Not Words and the National Academy for State Health Policy.