While the Medicare buy-in and new public health insurance option both likely dead for this bill, there are still provisions for public health insurance and public health care in the bill. These provisions include:
Medicaid expansion. Both the House and the Senate bills are projected by the CBO to cover 15 million more Americans with Medicaid or CHIP than current law (although Paul Waldamn projects the difference to be 15 million in the House bill, and 12 million in the Senate bill). Both Medicaid and CHIP are public health insurance options, and the fight to expand them is ongoing. This fight is ongoing. The House bill expands Medicaid to Americans at or below 150% of the poverty level, while the Senate sets the figure at 133%.
Community health center expansion. In exchange for his vote on cloture, Senator Bernie Sanders secured funding in the Senate bill that will double the number of community health centers in America:
The House bill provides $14 billion in funding for the federal health centers and service corps. Sanders says that indications from the White House and Democratic leadership are that there is a "good chance" the final bill will do the same. That would translate to health centers in 10,000 more communities throughout America within 5 years, and increase the number of people served by over 100 percent, to 45 million. It would also create 20,000 new primary care practitioners, dentists, nurses and other healthcare professionals. Sanders emphasizes a George Washington University study that shows the $14 billion expenditure would save money--$23 billion in Medicaid alone--"because you're keeping people out of the hospital and out of the emergency room. Now if this is not a win-win-win situation, I don't know what is," he says.
Going beyond public health insurance, this is public health care. Also, as passage makes clear, this fight is also ongoing, since we are talking about "good chances" instead of "done deals."
Community Living Assistance Services and Supports Program The CLASS provisions in the health care bill are a government-run program that will provide individuals long-term disability care. The program was championed by the late Ted Kennedy. The CBO estimates the program will have 10 million enrollees by 2019 (page 3).
Always a champion of the people, Lieberman previously claimed that he would filibuster the bill if the CLASS program was not removed. While Lieberman, who is always true to his word, failed to follow through on his threat, the fight for this public program is not over.
As Ed Kilgore astutely noted, the divide among the center-left over the health care bill is, and has always been, between:
Centrists / Third Way / neoliberals who favor expanding health insurance through regulated and subsidized private providers,
and
Left / liberals / progressives who favor expanding health insurance through public providers
If this is the central ideological battle among Democrats--and I have never seen a better analysis arguing otherwise--then the public option fight always encompassed more than just the creation of a new public health insurance program. It included Medicare, Medicaid, CHIP, community health centers, the CLASS act, and more. While some of those fights are over, not all of them are. This article lists three public options fight that are ongoing.
Even though the Medicare buy-in and a new public option program appear to be distant possibilities for this bill, champions of public health insurance and public health care in Congress should be demanding expansions of other public health programs in return for their votes. This is what Bernie Sanders did in the Senate, and he got some real results. With many Blue Dogs and Conservadems primarily looking for symbolic victories that allow them to differentiate themselves from the left, the Sanders model can be replicated and other victories can be achieved.
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