The Washington Post

States consider providing public health coverage

- PAIGE WINFIELD CUNNINGHAM paige.cunningham@washpost.com

The Trump administra­tion has promised states more flexibilit­y in how they run their Obamacare marketplac­es. But creating a state-backed “public option” plan may not be what Centers for Medicare and Medicaid Services Administra­tor Seema Verma had in mind.

Half a dozen states are looking into creating a public option — either as a stand-alone plan or a buy-in to Medicare or Medicaid — hoping to entice more of the uninsured by offering a more affordable choice. It’s an idea Congress considered but then discarded while writing the 2010 health-care law but is increasing­ly touted by Democrats as a way to achieve universal coverage.

But states may be limited in how far they can go. They need to ensure the plans closely mirror coverage already being sold in marketplac­es — otherwise, they must request permission via waivers from the Trump administra­tion, which has emphasized private health options and has appeared less enthusiast­ic about an expansion of government-backed coverage.

That’s something Washington state tried to avoid. The state is working on launching a public option by 2021, which will offer somewhat lower premiums than its competitor­s by paying lower rates to doctors, hospitals and other health providers.

To avoid any potentiall­y messy run-ins with the Centers for Medicare and Medicaid Services, Washington will provide coverage through a commercial plan that is already approved to sell on marketplac­es. State legislator­s considered requesting a waiver from the agency so they could undertake more ambitious changes — like structurin­g the plan’s subsidies in alternativ­e ways or trying to capture more savings — but ultimately rejected that idea.

“We ruled it out early on because we didn’t want to even ask,” said Jason McGill, senior health policy adviser to Gov. Jay Inslee, a 2020 Democratic presidenti­al candidate. “We felt that it would have been a nonstarter with the current administra­tion.”

The administra­tion has made clear what kinds of things it would approve: moves by states to ease Obamacare requiremen­ts or to let states apply its subsidies to leaner, cheaper plans. Verma has frequently criticized the Affordable Care Act as overbearin­g, stressing that the agency is doing everything it can to ease the law’s requiremen­ts.

Verma has also been publicly critical of Medicare-for-all ideas advanced by Democrats on Capitol Hill, warning that they would ruin the Medicare program and calling the proposals “the greatest threat to the American health-care system.” The agency didn’t respond to a question about how it would respond to a state waiver request for creating a public option.

“When you look at the new guidance, there’s an emphasis on private options,” said Chiquita Brooks-LaSure, managing director for consulting firm Manatt Health. “We would just have to see what the administra­tion would say if a state came up with a waiver proposal.”

Other states are also eyeing public option plans, although their progress has been slow. New Mexico has formed a working group and set aside $140,000 to examine the idea after abandoning an original proposal to create a Medicaid buy-in. Colorado passed a bill directing state agencies to draft a plan by November for how a public option could be designed and how it would be sold.

The Connecticu­t House passed a public option bill in the spring, although it later stalled in the Senate. The Nevada legislatur­e passed a public option bill two years ago, but it was vetoed by Republican Gov. Brian Sandoval. Public option bills have been proposed in Maine, Massachuse­tts, Minnesota, Missouri, New Hampshire, New Jersey and Oregon.

United States of Care, a group formed by former Centers for Medicare and Medicaid Services administra­tor Andy Slavitt, recently released a playbook for states considerin­g a Medicaid buyin — a form of a public option plan.

There’s a clear problem many of these states are trying to solve: Obamacare plans that, for many Americans, are still too expensive. While there are signs that marketplac­es have been stabilizin­g, costs are still prohibitiv­e for many consumers, especially those who qualify for only minimal subsidies or none at all.

The average monthly premium for a 40-year-old purchasing a midrange “silver” plan is $495 before subsidies, according to research by the Kaiser Family Foundation, a nonprofit that focuses on national health issues. And then there are hefty plan deductible­s; the average annual silver plan deductible for medical and prescripti­on drug coverage is $4,375, according to the foundation.

 ?? JOVELLE TAMAYO ?? Washington state legislator­s considered requesting a waiver to make more ambitious changes but rejected that. An adviser to Gov. Jay Inslee said it would’ve been a non-starter with federal officials.
JOVELLE TAMAYO Washington state legislator­s considered requesting a waiver to make more ambitious changes but rejected that. An adviser to Gov. Jay Inslee said it would’ve been a non-starter with federal officials.

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