Health Care Expansion

Supporters of single-payer health care marching at the state capitol in Sacramento, Calif., in April 2017. California Gov. Gavin Newsom, who took office this week, backs health coverage for more undocumented immigrants and bigger premium subsidies in the state.

Democratic-led states and cities are moving swiftly to push expanded public health-care proposals following their November midterm victories, drawing criticism from some Republicans and spurring debate over the potential high costs.

In Colorado, Democrats in the legislature introduced legislation for a public option. New Democratic Gov. Jared Polis, who talked about universal health care during his campaign for office, said he is creating an Office of Saving People Money on Health Care, and in his State of the State address Thursday called for "a health care system where no person has to choose between losing their life savings and losing their life."

California Gov. Gavin Newsom, who also took office this week, has proposed health coverage for more undocumented immigrants and advocated bigger premium subsidies, while saying he will seek federal authority to pursue a state single-payer plan.

And Washington Gov. Jay Inslee, who is weighing a presidential bid, has proposed a bill to add a government-sponsored option to the state’s Affordable Care Act exchange.


State Democratic officials, sensing a political advantage on health-care issues for the first time in years, are looking to fulfill campaign pledges that helped them retake gubernatorial and legislative offices. Some hope to tap into the energy behind a progressive push for “Medicare for All” universal health plans.

Almost a dozen states including New Mexico, Maine, Nevada, Delaware, Oregon, Connecticut, Wisconsin, Michigan and Illinois are exploring a public coverage buy-in or a more-expansive state plan — or have new governors who support those ideas.

“We’re seeing a new burst of energy,” said Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute. “We have a wave of new governorships, and there’s a lot of energy on the progressive side of the spectrum.”

But this push faces resistance from Republican officials and some health-care industry leaders, who argue that Democrats are overreaching and badly misreading the message from the midterm elections.

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Sen. Bill Cassidy (R., La.), in a series of tweets this week, criticized plans by California’s new governor.

“It is not a basic right to come to the U.S. illegally and force U.S. citizens to pay for your care,” Cassidy said. “And basic rights for American citizens cannot be supported by unsustainable programs.”

America’s Health Insurance Plans, a trade group for the industry, is closely watching the state plans and warning against sweeping solutions that don’t allow flexibility for individual consumers. In some cases, insurers risk losing customers to expanded state options.

“We also know that Americans want health care that works, not a one-size-fits-all health-care system,” said Kristine Growe, a spokeswoman for the group. “They want to improve what’s working and fix what’s broken.”

States looking to pursue expanded coverage also will have to wrestle with how to fund the initiatives and decide which residents would benefit. The Trump administration is unlikely to support the use of federal dollars for such proposals, leaving states to figure out how to keep costs down.

In California, Newsom proposes a fine on those who don’t get health coverage. Democratic New York Mayor Bill de Blasio, who wants expanded primary care for everyone in the city, would pay for it with about $100 million a year in direct city spending.

Inslee’s plan for Washington would keep costs down by paying providers at Medicare rates, although providers may balk at those reimbursement levels. State officials are seeking to partner with carriers to provide standardized plans, which typically have set co-pays and coverage.

Similar state efforts were taking root before the ACA was enacted in 2010. The passage of that law negated the need for some of the initiatives and spurred a political backlash damping enthusiasm for expanded coverage proposals.

Democrats are betting that the public’s mood has now shifted back. The resurgence of state efforts is putting pressure on congressional Democrats, who remain divided on whether to push for Medicare for All, as the party’s resurgent progressive wing wants, or follow the more-modest path of amending the ACA, as favored by centrists who are critical to the Democrats’ House majority.

At least two hearings on Medicare for All are expected this year in the House, and new Budget Committee Chairman John Yarmuth (D., Ky.) has asked the Congressional Budget Office to study the financial impact of single-payer health-care bills.

While the proposals reflect successful Democratic messaging on health-care, they also amount to an acknowledgment that gaps persist under the ACA, as significant groups of people—especially those who don’t receive government help—remain unable to get or afford coverage.

“The million-dollar question is how to help people who aren’t receiving subsidies,” said Jason McGill, senior health policy adviser to Inslee.

The Democratic moves follow a period in which GOP-led states, backed by the Trump administration, sought ways to curtail the ACA. The likely result is a wider divide on health care between Democratic-led states seeking to expand the health law and GOP-held states eager to roll it back.

Idaho’s new Republican governor, Brad Little, said in his state of the state address on Jan. 7 that he would press ahead with an executive order letting insurers sell plans that don’t comply with the ACA.

“For every liberal state looking to expand, a conservative state is looking to do the opposite,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation.

Colorado Politics contributed.

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