Republicans had no serious ideas when they held on to Congress and won the White House last year. Democrats are already preparing, especially on health.
On a mild day in January 2011, Republicans in the House voted to repeal the Affordable Care Act. It was the first of more than 80 attempts to dismantle the landmark law. Almost seven years later, the ACA has helped tens of millions of Americans get health coverage and changed the landscape of our nation’s health care system.
What has not changed are the minds and hearts of congressional Republicans. When they unexpectedly held onto both chambers of Congress and won the White House last year, they had no new serious policy ideas. They keep repeating that relentless partisan battle cry from 2011: repeal and replace.
We cannot let this happen to Democrats. Even as we defend the ACA, we must be ready to actually legislate the day the gavels in Congress are back in our hands, and that requires serious, progressive and practical proposals.
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The good news is that Democrats are already hatching substantive ideas to expand access to quality, affordable health care. Several senators have plans that build on Medicare. Vermont Sen. Bernie Sanders, an independent allied with Democrats, has championed Medicare for All, which would give every American coverage through the federal health insurance program for seniors. Michigan Sen. Debbie Stabenow wants Medicare coverage for anyone over the age of 55.
Sens. Chris Murphy of Connecticut, Tim Kaine of Virginia and Michael Bennet of Colorado have proposals to open up Medicare to anyone who buys insurance on their state’s exchange. Each of these serious ideas deserves the consideration and scrutiny that comes from a public hearing — and a transparent, bipartisan process.
My own proposal, which I introduced Wednesday with 18 other senators and Rep. Ben Ray Lujan, is the State Public Option Act. It would let states unlock their Medicaid programs to anyone who wants the coverage, giving Americans a public health insurance option on their state’s exchange.
Why Medicaid? Frankly, this program — already serving 69 million people — is underrated. It has a large provider network and the same positive ratings as private insurance but at a much lower cost to the government. Based on partnerships between state and federal governments, Medicaid also gives states the flexibility to adapt services and models of care based on their individual needs.
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If my bill became law, states would be allowed to open up Medicaid to give every family access to health insurance on the individual market — and it would cost less than a tenth of their income. The 157 million Americans who already have insurance from their employers could decide whether they want to keep it or move over to a Medicaid plan.
Of course, this will not be free. But a state public option is a good deal. In 2015, the United States spent $3.2 trillion on health care, or about $10,000 per person. Lowering costs and spending federal dollars wisely requires a focus on prevention — an approach that is possible when people have access to affordable insurance.
My plan would build on the success of Medicaid and the ACA, and help the nearly 30 million Americans who still do not have insurance. The grandfather of Medicaid would almost surely approve. When former president Lyndon B. Johnson unveiled his plans for the program that would become Medicaid, he reflected on the future of public policy in the United States. “The challenge of the next half-century,” he said, “is whether we have the wisdom to use that wealth to enrich and elevate our national life, and to advance the quality of our American civilization.”
More than 50 years later, we are still searching for that wisdom. When the next round of debate on health care policy comes, Democrats must be ready to get it right.
Brian Schatz is a Democratic senator from Hawaii.