As debate in the country has raged on over Republicans’ terribly unpopular ACA repeal bill, those on the Democratic Party’s left have argued that now is the time to push for ideas like universal healthcare, single payer and/or a public option. They charge that the lack of a public option in Barack Obama’s ACA was a serious mistake, gave the health insurance companies too much power and helped lead to the situation in Iowa where the three major insurers are pulling out in 2018.
They should be encouraged then by what Democratic leaders in Iowa are proposing.
Last week Senator Matt McCoy, Representative John Forbes and former Senator Jack Hatch laid out their idea for a Medicaid public option for Iowa. Since then, the idea has been catching on among other Democratic elected officials and affordable healthcare advocates. The Des Moines Register weighed in with a full editorial in support of it.
“Republicans in Iowa, including Gov. Kim Reynolds, should support and pursue opening Medicaid to more residents,” the Register’s editorial board wrote. “Those with higher incomes could pay the entire cost. There is not a better alternative on the table for Iowans who buy coverage on their own, including the self-employed, small business owners and early retirees. In fact, there may not be a better alternative for people in any state. Building on Medicaid to insure more Americans could move the country toward a universal system of health coverage, which has never looked more appealing.”
The Democratic proposal is essentially a “Medicaid-for-all” public option, where anyone, regardless of income, could be allowed to purchase an individual plan run by the state. That would help cover the 72,000 Iowans who are looking at losing their health insurance at the end of this year. It would also return much of Iowa’s Medicaid operations to state control following the disastrous privatization move. The state infrastructure to run such an operation is still largely in place even after Terry Branstad’s Medicaid moves.
The program would utilize the ACA’s federal funding dollars to help cover some of people’s cost for those at 138% to 400% of the federal poverty line. Anyone who is above 400% can still purchase it, just without subsidies. Federal officials would still have to sign off on such an idea, however.
By allowing anyone to purchase from this state market, you can get extra people to pay into the system, making it more financially stable in the long run. One of the problems with the current setup is that the private insurers take all the healthiest and wealthiest people off the top for their other plans, causing higher costs for the riskier markets. And with the unfortunate situation with nearly all individual plan insurers pulling out, many people would buy them.
While Republicans at the national level are attempting to repeal large sections of the ACA, implementation of that would take several years if passed. This proposal for Iowa could cover people during that time.
From a political standpoint for the party, there’s also a messaging benefit that isn’t touted as much as it could be. If you asked most voters how Obamacare/the ACA worked, they wouldn’t be able to give a clear answer. From percent of poverty eligibilities to marketplace plans to Medicaid state expansions to subsidies to risk corridors, the ACA was a complicated system. A Medicaid public option system offers a much easier-to-understand plan: anyone can pay in, anyone can benefit.
Many on the progressive left would like to see a single-payer system implemented at the national level. For the time being, this proposed plan by several Iowa Democrats might be the best path available at the state level until political circumstances change at the national level. However, if progressives would like to see Democrats go even further on the topic in Iowa, they now have key, supportive Democratic legislators like McCoy and Forbes who they can reach out to and work with.
And that part of this development is important. There’s been an awful lot of cynicism and frustration in Democratic circles after the election, part of it for very good reason. People from all ideological backgrounds in the party have been disappointed with how little the party has seemed to change following Trump’s election, including on policy issues.
But this is a situation where state Democratic leaders have stepped up and produced a real, concrete plan that candidates could run on if they so choose. Much of it came as a result of Jack Hatch’s book, No Surrender: Building A Progressive Agenda, where he laid out a host of policy proposals and has since been pushing elected officials within the party to adopt them. For candidates looking for policy suggestions, as well as progressive activists interested in a message for the party, it’s a good place to start to get ideas from.
Despite the justified frustration among many progressives about the party’s actions post-2016, there are some people who are doing forward-thinking actions. Activists should seek those folks out and see where they can work together.
by Pat Rynard