Time for a public option for health care in Delaware, Senate leader says

The News Journal

Senate Majority Leader Margaret Rose Henry has represented the 2nd Senate District, covering East Wilmington and areas of New Castle, since 1994.

If you’re one of the 24,000 Delawareans enrolled in a health insurance plan through the individual marketplace, you already know that only one insurer – Highmark Blue Cross – is available to you.

You probably also know that pre-subsidy premiums for a Highmark plan increased by 25 percent this year. It isn’t just a household budget problem, either. Overall health care expenditures are growing faster in Delaware than in almost any other state.

The Affordable Care Act was a major step forward for the country and for thousands of Delawareans who are now eligible for Medicaid or private health insurance. Still, the fact is that even with premium tax credits, coverage isn’t always affordable for everyday people.

Some believe Congress should repeal the Affordable Care Act. Others believe in a European-style single-payer system. The merit of either position is virtually moot for the average Delawarean.

Whatever say our little state has in the national health care debate is drowned out by the utter dysfunction in Congress, K Street, and the White House. Delaware’s residents and health care market are, oftentimes, at the mercy of forces beyond our borders.



But it doesn’t have to be this way. We don’t have to wait for Washington to reform health care, and we don’t have to choose between complete deregulation and a budget-busting state program. There is a third option – a high-quality, cost-effective alternative to private health insurance – and it already exists.

It’s called Medicaid. It covers more than 200,000 Delawareans. And this week I introduced legislation to explore a buy-in program that could make Delaware the first state to offer it as a public option for thousands more.

Under the ACA, people in most states are eligible for Medicaid if their annual income is less than 138 percent of the federal poverty level (FPL), which comes out to about $34,000 for a family of four. Under a buy-in program, anyone – including those above 138 percent of the FPL – could pay to enroll in Medicaid.

Coverage levels and premiums would be set by the State, which means that we could control the costs of a buy-in program and even keep it budget-neutral in the long run. There’s even the possibility that an innovation waiver could make Medicaid buyers eligible for the same federal tax credits that reduce premiums for marketplace buyers between 138 and 400 percent of the FPL.

A public option is just that: an option. Anyone could still enroll in private insurance if they prefer. But a Medicaid buy-in program would provide thousands of working Delawareans, young adults, and middle class families with an alternative to private insurance, and could incentivize private insurance to keep costs low.

Even if you aren’t on Obamacare, making greater use of Medicaid makes sense for taxpayers and for Delaware’s health care economy. Health care expenses have grown about 40 percent more slowly for Medicaid than private insurance expenses over the last 30 years, and research shows that health care expenditures are about 22 percent lower for Medicaid enrollees than private insurance enrollees, even though both consume health care services equally.

This idea isn’t as radical as it might sound. Two Republican Congresses passed legislation enacting Medicaid buy-in options for states in 1997 and 1999, and many states, including Delaware, offer a narrower Medicaid buy-in program for working adults with disabilities.

The State of Nevada recently passed legislation that would have allowed anyone to buy Medicaid, but the bill was vetoed due to a lack of specifics.

That’s why this study group is so important. Medicaid buy-in is a promising opportunity for us to expand health care access and control costs in a fiscally responsible way, and Delaware has the chance to be a national leader in doing it – if we take the time to study this policy, to be thoughtful about it, and to put forward a serious proposal.

In about two weeks, I will walk out of the Senate Chamber for the last time. Until then, I will continue to fight as hard as I can to be a voice for working people and our most vulnerable neighbors. It’s my hope that this study group will help Delaware continue that fight well after I’m gone.

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