On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA) into law. Dubbed by many “Obamacare,” the President’s healthcare reform bill in many ways represents the most the sweeping healthcare legislation since the advent of Medicare and Medicaid under President Roosevelt’s New Deal initiative. In similar fashion, the ACA has been the epicenter of heated controversy that continues to deepen the partisan divide between both Republicans and Democrats. Indeed, the continued existence of Obamacare may very well be at risk should President-elect Trump decide to make good on his threats to overhaul the existing law and its complex provisions.
To remodel the U.S. healthcare system to better mirror that of other developed nations around the globe, President Obama opted to adopt an individual mandate system, coupled with public subsidies for private insurance as an alternative to a single-payer system such as those in the Nordic social democracies championed by some progressives. Some prominent leaders on the left—including Senator Bernie Sanders (I-VT)—have voiced criticisms that President Obama’s law still falls considerably short of providing a legitimate solution to the inequity and inaccessibility that blights the U.S. healthcare system. In doing so, some on the left, including Sen. Sanders, have pushed for the formal adoption of a single-payer system in which the government directly finances healthcare and would by extension obviate the need for private insurers beyond certain supplemental coverage. However, in lieu of persisting struggles in the law’s implementation (particularly due to unforeseen enrollment difficulties regarding young, healthy recipients versus those in need of coverage for existing medical reasons), some lawmakers have resurrected debates about a potential “public option” which would effectively function as a single-payer alternative under the existing healthcare bill.
Ultimately, under a public option, the government would offer insurance that would compete directly with private insurance plans on the exchange market. Fueled by talks of rising premiums and withdrawal of major insurers including Aetna and UnitedHealth Group from several state exchanges, Republicans have continued to urge for the law’s repeal while Democrats continue to scramble for a solution to preserve what will perhaps be President Obama’s most lasting legacy. While a formal public option model remains somewhat vague with regard to implementation, Elizabeth Carpenter of Avalere Health has proposed a system in which the “government would contract with private companies to set up doctor networks” which would in theory streamline accessibility to medical care for Americans from all socio-economic strata. Others, including Tom Howell of the Washington Times, have illustrated the public option as tantamount to “Medicaid for all,” in which the government acts as the direct insurer.
Regardless of the potential solutions available, some critics have noted that a public option functioning as a quasi-single-payer teaser could incite resistance from medical providers who certainly profit more from private insurers than they would public insurance. For instance, according to the Washington Times, such a model could lend itself to “insurers […] balking at competing with a government-run plan, saying it [the government] would effectively set rates in the open market.” Some on the left have championed pushing privatization as far out of the healthcare industry as possible. However, many, including President Obama himself, seem to be hesitant to completely opt for a public model both in lieu of the political currency needed to pass such a system and the arguable value of a competitive market that could drive down costs and maximize coverage. Yet as the election results settle in, the future of Obamacare and a potential single-payer-esque option remain all but uncertain and up for grabs.