The Public Option: The Heart of a Moral Vision

~ by Rev. Linda Hanna Walling, Faithful Reform in Health Care

President Obama commented that the public health insurance option is but a “sliver” of the proposals for health care reform.  In terms of sheer numbers he is exactly right.  With the millions of additional persons who will have insurance through the proposed Medicaid expansions and employer mandate, the number of persons who will actually need (or choose) the public health insurance option will be a “sliver” of the number of persons with health insurance in the U.S.

From a moral values perspective, however, a public health insurance option (or something that achieves the same end of truly affordable insurance with comprehensive coverage) represents the heart of these legislative proposals – and the heart of who we are as a nation.  Do we want to guarantee that everyone has truly affordable insurance that provides access to needed health care – or not?

Over the years, we have taken numerous steps toward accepting moral responsibility for our most vulnerable populations. We have recognized that those with the lowest incomes, our elderly, our veterans, and our Native American populations need the support of our collective resources for health care.  And we have responded appropriately.  The crisis facing us now is the millions of persons who do not have employer-sponsored health care, do not qualify for any of these programs, and cannot afford to buy insurance or pay out-of-pocket for their medical expenses.

The public health insurance option is proposed to address that reality.  Reflection on this provision, or a comparable alternative, begins not with the public option itself, but with the proposed individual mandate for insurance. There is broad understanding that such a mandate is a given.  It is necessary to achieve universal coverage, to maximize the risk pool, and to spread the costs accordingly.  It is supported by the private insurance industry because millions more persons will be buying health insurance.  But they have used the individual mandate as a condition for their willingness to eliminate consideration of pre-existing conditions (guaranteed issue) and to accept limits on premium costs compared to payout for claims (medical-loss ratio).

From a faith and justice perspective, health care reform advocates generally have opposed the individual mandates at the state level because they have proven to be unworkable and inequitable. The plans ultimately were too expensive, and government entities simply couldn’t adequately provide sufficient subsidies to make the plans affordable.  The advocacy community has not resisted the proposed federal individual mandates because of the companion provisions – the  Medicaid expansion, the employer mandate, the public option, and the public subsidies.

It is troubling that even with the public option and other provisions, it is projected that several million persons still will remain outside the system because the expansions and subsidies will not likely go far enough in providing affordable and comprehensive coverage.

Even more troubling, however, is that without a public option, or a comparable alternative, it is almost certain that even more persons will not have access to affordable insurance.  Instead, millions could be forced into for-profit private insurance plans in which there are no guarantees that the combined costs of premiums, co-pays and out-of-pocket health care expenses would actually forestall financial hardships for families in need of medical care.

Is it possible to guarantee affordable and comprehensive coverage without a public option?

Download the entire document from which this except was taken — “How the Public Option Measures Up to A Faith-Inspired Vision of Health Care” — at


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