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Louis Jacobson
By Louis Jacobson December 15, 2021

Public option for health insurance moved to back burner

During the 2020 Democratic presidential primaries, candidates raced to distinguish themselves over their approach to health insurance policy. 

More progressive candidates like Bernie Sanders said they would pursue a universal single-payer plan like Medicare, in which the federal government pays all the bills. More moderate candidates, including Joe Biden, favored what's called the public option, under which Americans under 65 could choose to participate in a Medicare-style plan run by the government, or stick with private insurance. 

President Barack Obama envisioned a public option as a key part of his health insurance reform law, but gave up on it during negotiations with opponents in Congress. As a presidential candidate, Biden proposed adding the public option as a way to fix the shortcomings of the Affordable Care Act.

But for all the attention the public option got during the campaign, it has faded from the Democratic agenda on Capitol Hill.

With Democrats barely controlling the Senate, and universal opposition to his agenda from GOP senators, Biden has had to rely on a special procedure known as "budget reconciliation" to bypass the filibuster and pass his agenda.

The Biden administration has used the reconciliation process to pursue two bills: a coronavirus and economic relief bill called the American Rescue Plan, which passed on a party-line vote weeks after Biden was inaugurated, and a safety net expansion bill known as the Build Back Better bill, which is currently pending in the Senate following passage in the House. 

Neither of these bills included the public option.

"It is fair to say that the public option is 'on hold,'" said Linda Blumberg, a fellow and health care policy specialist at the Urban Institute. Enacting the public option "has been and will be a real political challenge."

There's still time for Biden and congressional Democrats to pursue legislation creating a public option in 2022, but for now, the idea is on the back burner. We rate it Stalled.

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