The largest public option in the health care bills is, and has always been, the significant expansion of Medicaid. In terms of the number of people it covers, this expansion dwarfs any other public option expansion currently on the table in Congress. In terms of the type of people it covers, the Medicaid expansion includes a much higher percentage of Americans who are uninsured, and a much higher percentage of Americans who are in poverty, than any other public option expansion on the table in Congress.
The CBO report on the bill passed by the House (PDF, page 11), and the CBO report on the bill that was sent to the floor of the Senate (PDF, page 20), both project that the bills will add 15 million more Medicaid subscribers than current law. All of those 15 million are at 150% of the national poverty level or lower in the House bill, and 133% or lower in the Senate bill. Also, virtually all of the new people who will be covered by Medicaid in both bills are uninsured.
By comparison, the Medicare +5% public option was projected to cover 10 million people, the negotiated rates public option that passed the House was projected to cover 6 million people, and the opt-out public option was projected to cover 3-4 million people. Even in the July version of the House bill, the Medicaid expansions were projected to cover 11 million new people (PDF, page 17), larger than any of the other public option expansions reviewed by the CBO. As such, at all times, the Medicaid expansion was the largest expansion to public health insurance in the various bills that passed through Congressional committees.
Providing 15 million low-income, uninsured Americans with public health insurance is also why so few House Progressives carried through on their earlier threat to sink any health care bill without a new public option program tied to Medicare rates. After all, House Progressives both want to help people in poverty, and they disproportionately represent districts that would have been impacted by the new Medicaid coverage. It would have been difficult for House Progressives to explain to their constituents why they denied them health care, especially when the only electoral pressure most Progressives face comes from primary challenges.
There is another reason any Progressive explanation for defeating the bill would have been difficult. In their July 30th letter, House Progressives were advocating for a Medicare +5% public option, which would have covered 10 million people, to be added to a bill with a Medicaid expansion that, at the time, covered 11 million people. Such a bill would have increased the number of people with public health insurance by the exact same amount as the bill that eventually passed the House (15 million through the Medicaid expansion and 6 million through the negotiated rate public option in the exchange). In both pieces of legislation, 21 million more people are covered with public health insurance.
Defeating the vast Medicaid expansion is the pill House and Senate Progressives have been unable to swallow. If you want to know why Progressives in the House and Senate are not blocking the bill, Medicaid expansion is the reason.
In their quest to get votes, the Democratic leadership seems to have accurately calculated that a Medicaid expansion would lock in Progressives throughout the process. It would have been nice if they could have figured out something palatable that would have locked in all the Blue Dogs and Conservadems from the start, too.
|
STATE BLOGS
