A judiciously cautious approach to the “public option” [Boss Insurance]

A Judiciously Cautious Approach To The “Public Option”

Review Editor’s Note: Editorials represent the views of the Star Tribune Editorial Board, which operates independently of the newsroom.


MNsure, the state’s online health insurance marketplace, rarely makes headlines these days. But its glitchy launch in 2013 and the difficulties encountered during its first years of operation offer both humbling and lingering lessons for policymakers.

The American healthcare system is complex, especially when it comes to coverage. Navigating between deductibles, copayments, coinsurance, in-network and out-of-network care is daunting for those who rely on private health plans. Public programs, such as medical assistance and health insurance, which have eligibility requirements, can also be difficult to negotiate.

The hectic rollout of the Affordable Care Act has made it clear that any change in health insurance, no matter how well-intentioned, can create confusion and anxiety among consumers. Careful consideration is essential for any future reform. Fortunately, Minnesota took this into account by carefully laying the groundwork in the 2023 session for what could be the next big state-level health care reform.

This is called the “public option”. There are different interpretations of what this means. But the classic definition is “a publicly funded, government-operated insurance scheme that competes directly with private health insurance coverage, with the aim of reducing premiums and underlying health care costs” , according to the Center on Health Insurance Reform at Georgetown University.

An example of a public option: Allowing Americans of all ages to enroll in the federally run and funded Medicare program (which typically serves those 65 and older) the same way they would purchase coverage from an insurer private. Other variations: allow people of all incomes to purchase coverage through medical assistance programs, which currently limit eligibility through income caps. Or allow the general public to subscribe to the government employee health care plan.

The goals, of course, are lofty: to move closer to universal coverage by making insurance more affordable and benefits broader for everyday consumers. The large size of government health programs could provide purchasing power to reduce coverage costs. A larger pool of enrollees could also help spread the cost of medical care provided to them, helping to cushion premium increases.

But with health care, “the devil is in the details,” as Professor Lynn Blewett of the University of Minnesota School of Public Health noted to an editorial writer this week. Launching a public option raises difficult questions, including:

  • Would those who subscribed to the public option cover the full cost of their coverage, or would government subsidies be required? If yes, how much would it cost?
  • What federal assistance could be leveraged to offset program costs?
  • How much would the premiums be for consumers? Would there be cost sharing, such as annual deductibles or co-payments? Would the benefits offered to member customers correspond to those currently offered to those registered in the public program?
  • What would be the impact on medical providers, who are already complaining that reimbursement for care for those enrolled in the public program does not cover costs?
  • Why have other states’ public options not lived up to expectations? A Politico article reviewing efforts in Washington, Colorado and Nevada suggests measures there have failed to cut costs or struggled to register.

The 2023 Minnesota legislative session brought national attention to the ambitious slate of policies passed by the DFL state government trio. The public option legislative language adopted, however, took a laudable and cautious approach.

He was in no hurry to pass a law launching a public option. Instead, it sets up a process to answer many of the questions raised by this editorial.

The bill calls for actuarial analysis and other expertise to assess the potential benefits, costs and impact of a public option. A report is due in the Legislative Assembly on February 1, 2024. The wording of the bill also calls for a proposed implementation plan in early 2027, with additional legislative approval likely needed to move forward. .

It’s a quick schedule, but reasonably gathers information and relies on expert analysis. It also gives the executive branch wide latitude to build on those findings and tailor a public option for Minnesota. A possible answer to also keep in mind: A public option might not work here given the lackluster experience in other states and the potential to upend other pioneering efforts in Minnesota to keep coverage affordable. Lawmakers will also have time to digest the experts’ conclusions.

It’s a sensible place to land. Lawmakers deserve praise for their responsible restraint. If adopted, a public option would be radical public health reform. It deserves careful and informed consideration before moving forward to ensure that it would serve the best interests of the people of Minnesota.

Members of the editorial board are David Banks, Jill Burcum, Scott Gillespie, Denise Johnson, Patricia Lopez, John Rash and DJ Tice. Star Tribune Opinion staff Maggie Kelly and Elena Neuzil also contribute, and Star Tribune CEO and publisher Steve Grove is an advisor to the board.