Delgado supports public option
Preserving private coverage seen as pragmatic tact
Although Medicare for All seems to be one of the main calling cards of outspoken Democratic House freshmen and progressive 2020 contenders, Rep. Antonio Delgado is placing his bet on a different path forward to universal health care in America: The Public Option.
Delgado, D-rhinebeck, was the lone freshman last week joining two veteran House Democrats — Rep. Brian Higgins of Buffalo and Rep. John Larson of Connecticut — in re-introducing a public option bill, the Medicare-x Choice Act. The act was put forward by Higgins in 2017.
The measure would give those without health insurance the option of buy
ing into Medicare, the system that provides health coverage to close to 60 million seniors, 3.6 million of them in New York.
In contrast, Medicare for All would largely dismantle the current system of private health insurance and replace it with “single payer” — the U.S. government via Medicare.
The debate over these dueling proposals pits the unabashed progressives like Rep. Alexandria Ocasio-cortez, D-bronxqueens, and Sen. Bernie Sanders, I-VT., against more centrist Democrats like those in the New Democrat Coalition, a group of more than 100 House members including Reps. Sean Patrick Maloney, D-newburgh, and Anthony Brindisi, D-binghamton. Delgado, however, is in neither camp.
Delgado, who rode a Democratic wave last November to defeat former Republican Rep. John Faso for the upper-hudson Valley’s 19th Congressional District seat, has walked a fine line in his first three months in office. He has held 11 town halls throughout the district and said in terms of health care, he’s doing his best to reflect what constituents tell him.
“You have to make sure you’re hearing the folks on the ground, doing the work when you’re in D.C. and making sure you’re representing their interests to the fullest,” he said last week on a conference call with reporters. “I’ve done a lot of work with my team to make sure that we can own this space, and provide us some real direction when it comes to solving the health care crisis.”
Looming in the background is President Donald Trump and Republicans in Congress, who see “Medicare for All” as fertile ground for attacking Democrats by painting them as socialists because they favor governmentrun health care.
“Medicare for All is Obamacare on steroids,” said Seema Verma, Trump’s head of the Department of Health & Human Services’ Centers for Medicare & Medicaid Services.
The attacks are happening at the same time Republicans themselves face problems with their stance on health care. Senate Majority Leader Mitch Mcconnell, R-KY., last week had to talk Trump into delaying a new Republican effort to “repeal and replace” Obamacare — the 2010 Affordable Care Act — after a series of defeats in 2017.
Even so, Trump’s Department of Justice has joined in supporting a Texas lawsuit to topple Obamacare in court on Constitutional grounds.
A public option came close to being part of the original Affordable Care Act. It passed the House, which then was also controlled by Democrats. In the Senate, Sen. Charles Schumer supported it. But it died after moderate Sen. Joe Lieberman of Connecticut threatened a filibuster.
Obamacare became the law
of the land despite the absence of any Republican support. GOP lawmakers promised to starve it and then overturn it once the votes on Capitol Hill were there. That never happened.
The Affordable Care Act succeeded in driving down the number of those lacking health insurance from 44 million in 2013 to 26.6 million in 2016. New York’s rate of uninsured fell from above 10 percent at the time the ACA became law to six percent in 2017, according to the non-partisan Kaiser Family Foundation.
But the numbers of uninsured have begun to tick back up due to high deductibles and premiums for those earning too much to get Obamacare subsidies. Also, Republicans in Congress ended up cutting the Obamacare risk-pool by rolling back the requirement that all must have health insurance or pay a tax penalty.
About 28.5 million nationwide did not have health insurance as of the end of 2017, according to the U.S. Census Bureau.
So while Republicans focus on doing away with Obamacare and replacing it with a health care system under minimal government oversight, Democrats are debating what level of government involvement is necessary to achieve the goal of universal health insurance coverage.
The public option “would also allow folks who are happy with their employer-provided plans to keep them, but at the same time it would offer another more affordable coverage option to those in need,” Delgado said.
Delgado also stresses the benefits to rural areas like the one he represents, and elsewhere in upstate New York. Oftentimes, private insurers on Obamacare exchanges ignore rural regions, or the areas are represented by one insurer exercising a virtual monopoly.
The Medicare-x Choice Act would be administered separately from the Medicare used for senior citizens, and would be selffinancing, Delgado said. It would cap premiums at no more than 13 percent of household income. Those lower on the income scale would pay less than 13 percent.
Robert Field, a law professor and health care policy expert at Drexel University, said the public option would cause less of a shock to the medical system than Medicare for All.
“It’s definitely more practical and more politically feasible,” he said, pointing out that choice in health care has become ingrained in the American psyche. “You could fit it into the current ACA architecture. It wouldn’t disrupt the system as much as Medicare for All would.”
However, the debate on Capitol Hill might ultimately revolve more around propping up Obamacare — a path that House Speaker Nancy Pelosi appears to favor. She opposes Medicare for All. In 2009, Pelosi at first supported the public option, but ultimately deleted it from the final version of the ACA.
Obamacare, meanwhile, has been a relative success in New York. It is one of 11 states to operate its own health-insurance exchange — New York State of Health. The exchange reported last month that the 28 insurers offering various plans had signed up more than one million by Jan. 31, 2019, an increase of 6.5 percent over the previous year.
But those who lack health insurance through their employers in New York and elsewhere complain that without federal subsidies available to those in the lower-income brackets, policies on the exchange often come with high premiums and high deductibles.
Both Delgado’s public option and Medicare for All are aimed at fixing that imbalance. The competition of a lower-cost Medicare option would force private insurers to drive down rates, he said. However, cost estimates for Medicare for All reach as high as $30 trillion.
Delgado shies away from direct criticism of Medicare for All, preferring to extol what he sees as the positives of a public option.
“I’d rather speak about what I believe,” Delgado said in a phone interview Friday. “The focus is on how to craft a piece of legislation that gets to the heart of a complicated matter, that has the effect of bringing as many folks under the (health insurance) tent as possible.”