Hillary Clinton is once again embracing the public option. As Politico noticed Monday, the presidential candidate has added a section to her website stating that she still supports the concept of creating a government-run health plan to compete against private insurers, which she also backed backed during her 2008 campaign.
The public option was a deeply popular idea among progressives during the legislative battles over the Affordable Care Act in 2009 and 2010. Advocates argued it would lower costs and possibly serve as a bridge toward a single-payer system. The proposal also polled extremely well with the public. But it died rather brutally thanks to opposition from more conservative Senate Democrats, including Nebraska’s Ben Nelson, and independent Joe Lieberman. (In its place, we got Obamacare’s nonprofit health care co-ops, which seem to have been a flop so far.)
Given liberals’ infatuation with the public option, the most surprising thing about Clinton’s move is that it didn’t happen sooner. (Journalists have been wondering for a while why she hasn’t been pushing the idea.) Like much of her policy agenda, Clinton’s health care platform has suffered from the lack of a decent marketing hook. Everybody knows that Bernie Sanders is in favor of a national single-payer program, which, while both politically and logistically impracticable, is at least pretty easy for voters to understand and maybe get excited about. Clinton, on the other hand, talks about using the existing framework of the Affordable Care Act to push the country toward universal coverage and offers an array of targeted, wonk-approved ideas to do so, none of which are especially catchy. (Bulking up premium tax credits for people who buy insurance on the Obamacare exchanges, as she’d like to do, would be really, really helpful, but proposing it won’t exactly fill a stadium with cheering college kids.)
Throwing her arms around the public option should help Clinton with that problem. When Sanders talks about Medicare for all, Clinton can now talk about finally making the public option a reality, which might be the tiniest bit more plausible. Obviously, a Republican Congress would never abide. But Clinton suggests she’ll try to scoot around Capitol Hill by working “with interested governors, using current flexibility under the Affordable Care Act, to empower states to establish a public option choice.” This is an interesting approach—liberals occasionally talked about the idea of state-based public options in the years immediately after Obamacare’s passage—that would presumably take advantage of the ACA’s innovation waivers. Whether it would do much to advance the cause of health reform is hard to say—state versions of the public option would enroll fewer patients than a federal plan and thus would have less power to negotiate with health care providers and save money. But progress is progress.
In the meantime, Clinton has found something bright and glittery to offer progressives, and probably general election voters, on health care. It’s about time.
