I am a huge proponent of a single-payer system — or a national health insurance system, if you prefer. I have been all my life and will likely be until I die.
So this perspective comes from a believer. I don’t need convincing on the merits of a national health system. My concerns are purely political.
I am far from an expert in the gigantic volume of details and analyses of our brain-wrappingly complex current system for providing health insurance. But I very much understand the basics and want to keep this focused on the big picture.
One of the problems I’ve noticed in this debate over Bernie’s single-payer plan vs Hillary’s “let’s work with the ACA” plan is a general lack of understanding of what we can accomplish with the existing ACA scheme to broaden coverage, contain costs, and help tens of millions of Americans pay for their medical needs.
And I confess, I have not been an active enough advocate for improving the existing ACA law through regulatory processes. But I think our energies have been misdirected and I will from this point become a more educated and active proponent of squeezing out as many benefits as we can under existing law. I hope you all will do the same.
We don’t need 60 votes in the Senate to make the ACA work better. We need targeted advocacy directed at governors and agency regulators to expand coverage and contain costs.
Here is one example I came upon in my research of how we have been distracted and not nearly active enough as a community to fight for ACA improvements.
Under the ACA, the Office of Personnel Management (OPM) — essentially the federal government’s human resources department and the same agency that negotiates health care plans for federal employees — is responsible for negotiating Multi-State Plans (MSPs) to offer in the exchange. These MSPs exist as broader-based plans to compete with smaller, more local plans and give consumers at least two, broader, “model” options.
Under ACA law, OPM will eventually have to negotiate and offer at least two MSPs in all 50 states. And the law requires that one of these two offerings must be a nonprofit health insurance plan.
Now, here’s the interesting point. OPM has a lot of leeway in setting standards for coverage and costs for these MSPs. Through the normal regulatory process, they work with the MSP providers to ensure policies meet OPM requirements.
OPM has already found something like 154 MSPs for 30 states plus the District of Columbia. Here’s a fact sheet on the OPM’s work so far: www.opm.gov/…
Just think about this. We have lamented that the ACA doesn’t have a public option. But if the OPM is involved in finding MSPs and setting terms for MSP coverage, and if at least one of those offerings in every state is a nonprofit, and if we were to actively work on pressuring OPM to negotiate for the best possible plans, that’s not a public option on paper, but it could be pretty damn close in practice. And, it could eventually lead to an actual public option if OPM can’t find MSPs that meet their requirements.
And here is the tragedy in all of this. When OPM proposed the MSP regulation in November of 2014 to go into effect in March of last year, they received only 43 public comments. Here’s the link to the Federal Register: www.federalregister.gov/…
This is just pathetic. I admit, I didn’t offer my comments. I didn’t know about this rule-making process. I honestly didn’t even know about MSPs and OPM’s role in developing these plans. But I do now. And I will say this is something we can directly influence with direct grassroots activism.
And this is just one of the countless ways we as activists can squeeze out all we can from the existing ACA law.
So, not to bring this back to Hillary vs. Bernie, but as a question for advocacy, what makes more sense: Use the existing law and advocate to make it the best damn ACA we can, turn these MSPs into de facto public options, expand Medicaid, and work to negotiate lower costs and better plans to cover more people — things we can do right now, literally right this second. Or work to find 60 votes in the Senate for some future single payer national health system that is at least a decade away?
I’m a big believer of one in the hand is worth two in the bush. I’m also a big believer in not putting off until tomorrow what you can do today. We have so many opportunities to improve the ACA that we — you and I and all of us — can directly influence. Why not just do that?