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Health Aff 2010 Halpin 1117 24
Health Aff 2010 Halpin 1117 24
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A
s the 111th Congress drafted legis- provider charges through the bargaining power
lation for comprehensive health of a large government payer.
care reform, the proposal to offer The proposal to increase the role of govern-
Americans the choice of a so-called ment in achieving these aims fueled the con-
public option became one of the cerns and opposition of conservativesas well
most hotly contested issues. From the beginning as those of private insurers, providers, and
there was confusion, not only over what consti- other interest groups representing the supply
tuted a public option, but also what it would side of the health economy. Ultimately, the pub-
mean to the U.S. health care system and the lic option failed as a result of many factors, in-
American people. The public option raised the cluding lack of support from moderate and
long-standing question: What is the appropriate conservative Democrats, opposition from Re-
role of government in achieving health insur- publicans and health care interest groups, and
ance coverage for all Americans? ultimately an absence of strong support from the
We trace the rise and fall of the public option, White House.
as it came to be defined in the recent health care
reform debate, and as experienced by two pro-
ponents intimately involved in the process. We Chronology Of The Public Option
recount the public options emergence in Cali- Public health insurance, in the form of Medicare,
fornia in 2001 and 2002 and chronicle its demise Medicaid, and the Childrens Health Insurance
in Congress in 200910. Progressives supported Program (CHIP), has existed in the United States
a public option as an alternative to the for-profit for decades, as have proposals to expand those
health insurance industry, with expectations programs. However, the public option, which
that it would control costs, promote competi- first surfaced in 200102, represented an en-
tion, and prompt delivery reforms and lower tirely new idea. The concept was to offer a pub-
licly insured plan in direct competition with proposal; he did so in February 2007.6 His pro-
other options for private health insurance cover- posal encompassed the principles of CHOICE,
age, in the hope of driving down both premiums with each state creating a health insurance ex-
and underlying health care costs. change offering competing private plans as well
Birth In California The idea of a public op- as a new public plan option. Individuals and
tion within a state-based health insurance ex- employers could elect to purchase insurance
change was initially set forth in a proposal through the exchange.
known as CHOICE. This was part of Californias Edwards saw the public option as a potential
Health Care Options Project (HCOP),1 an initia- transition to single-payer insurance. In discus-
tive to update and develop ideas and options on sing the public option, he stated: American