Dave Helling

Dave Helling: Should a limited public option be part of health care reform?

Blue Cross Blue Shield of Kansas City announced Wednesday it’s pulling out of the Affordable Care Act exchange.
Blue Cross Blue Shield of Kansas City announced Wednesday it’s pulling out of the Affordable Care Act exchange. Andy Marso

It’s easy to lose track of important information when other stories get in the way. Russia, the budget, terror attacks and White House intrigue suck up a lot of oxygen.

Weren’t we focused on health care reform just a few weeks ago? Yes we were.

And as it turns out, while we’re all looking at other things, lawmakers in Washington are still working on a rewrite of the Affordable Care Act. There were two important developments over the last two weeks we should think about:

▪ Sen. Claire McCaskill, a Missouri Democrat, suggested uninsured individuals who can’t find any private coverage locally should be allowed to use the District of Columbia exchange.

▪ Some Republicans voiced support for the government automatically enrolling uninsured individuals in a coverage plan, with the cost paid for through existing tax credits.

Now we’re getting somewhere.

Both ideas address a key problem with the Affordable Care Act. Despite penalties for failing to enroll, hundreds of thousands of young Americans are still without health insurance.

They don’t sign up because they’re young, healthy and don’t have enough cash to purchase something they don’t think they need.

But the failure of healthy young Americans to get insurance has crippled many private insurance firms, which are withdrawing from health exchanges in the states. Blue Cross and Blue Shield of Kansas City announced just such a decision Wednesday.

That leaves some customers without a private insurance option.

McCaskill wants to solve the problem on the back end. Senate Republicans want to solve it on the front end.

Each approach has merit. But because both still involve the private insurance market, they may fall short of the goal of wider coverage.

Here’s an alternative. Instead of allowing the uninsured to buy coverage on the D.C. exchange, let customers without a private option in their counties buy Medicare instead.

In our area, that might mean individuals losing Blue Cross Blue Shield coverage would qualify for Medicare.

And instead of automatically enrolling young, healthy people in private insurance, put them in Medicare — for the price of their tax credits.

This isn’t a single-payer system. It isn’t a full public option, either, which some Democrats wanted five years ago. It wouldn’t change anything for people who get their insurance at work.

But it would provide a solution for the toughest cases — those without private options and those who don’t sign up for private insurance.

Insurance companies would squawk — they need healthy customers to pay for older, sicker patients. But they would have a remedy: Sell insurance in the counties they’ve abandoned. If insurance is available privately, Medicare wouldn’t be an option.

Others would claim this kind of set-up would hasten single-payer health care. As I’ve suggested before, that’s probably inevitable.

But not yet. America has a responsibility to help the uninsured find health coverage. A limited public option might be a way to do so.

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