- The Washington Times - Wednesday, July 27, 2016

More than two thirds of Obamacare’s health co-op’s have failed, yet Democrats who pushed the experiment during the 2010 health care debate are refusing to cede ground to corporate plans, saying the best Plan B is the “public option” that many of them wanted in the first place.

Sixteen of the original 23 co-ops have withdrawn from the Affordable Care Act’s web-based exchanges, mostly recently in Oregon, Connecticut and Illinois, despite $1.7 billion in taxpayer loans to the failed plans.

Democrats pushed the co-ops, or Consumer Operated and Oriented Plans, during the Obamacare debate of 2009 as a fallback to attempts to win passage of the public option — a government-run plan to compete with private companies in the new marketplace. Yet many of the co-ops had a hard time competing for market share, and in some cases the nonprofit plans appeared to underprice their products and then drown in medical claims.

Yet the 2016 Democratic Party Platform says health care is a “right, not a privilege,” so the party is doubling down instead of retreating from taxpayer-funded alternatives, highlighting the influence of primary challenger Sen. Bernard Sanders of Vermont, who pulled presumptive nominee Hillary Clinton to the left before backing her.

“This campaign is about moving the United States toward universal health care and reducing the number of people who are uninsured or underinsured,” Mr. Sanders told the Democratic National Convention in Philadelphia late Monday. “Hillary Clinton wants to see that all Americans have the right to choose a public option in their health care exchange.”

While the public option stops far short of the Medicare-for-all system that Mr. Sanders envisioned, it goes further than what Mrs. Clinton supported earlier in the primary.

Congressional Republicans, meanwhile, are heading in the opposite direction. They say it is time to scale back the government’s role in health care and recoup whatever money they can on the failed co-ops, underscoring how far apart the parties remain as President Obama hands his signature law over to his successor.

“I see virtually no room for bipartisan compromise on the basic question of health care coverage at this point,” said Timothy Jost, a law professor at Washington and Lee University in Virginia who closely tracks the health care debate.

The groundswell of Democratic support for the public option reflects a party that’s taking its cues from progressive voices such as Mr. Sanders and Sen. Elizabeth Warren, Massachusetts Democrat, rather than former Sen. Kent Conrad of North Dakota and other Democratic centrists who rebuffed the public option during the Obamacare debate of 2009-10 but no longer serve on Capitol Hill.

Mr. Conrad had pushed to allow states to start the co-ops, which are nonprofits designed to be responsive to residents’ needs rather than to investors’ demands.

But the dominolike fall of the plans has dented early hopes the program would create competition and slash prices. The plans lost hundreds of millions of dollars in their first year and didn’t attract anywhere near as many customers as they had hoped, leading to the swift collapse of nearly half of them in the run-up to Obamacare’s third round of sign-ups.

Three more toppled in recent weeks, with Oregon Health Co-op ceasing coverage on July 31, Land of Lincoln in Illinois on Sept. 30 and Healthy CT in Connecticut on Dec. 30, raising doubts about the future of the program and whether consumers in some parts of the country will have enough choices on the exchanges.

President Obama acknowledged this lack of choice in throwing his weight behind a “Medicare-like public plan” in a July 8 article for the Journal of the American Medical Association.

“Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited,” he wrote.

Caroline Pearson, a senior vice president at Avalere Health, a D.C.-based consultancy, said she could see it as a “fallback option” in areas where private plans have pulled out or declined to participate, though Democrats haven’t outlined how the public option would work or how they’d deal with pushback from private insurers who might view it as a rate-setting entity in America’s free market.

Even if it is doable, the public option would face considerable political opposition from Republicans who control both chambers heading into November’s election.

Speaker Paul D. Ryan recently posted a long-awaited Obamacare replacement plan that would rein in federal spending on health care and scrap government mandates and public health exchanges in favor of incentives designed to entice customers into private market plans.

For now, Republicans say the co-ops’ demise is exhibit A in their argument that a D.C.-centered approach to health care is doomed to fail, so Democrats pursue the public option at their own peril.

“When its big programs fail, the left’s answer is always bigger programs,” Sen. Ben Sasse, Nebraska Republican, said. “With co-op failures and crummy choices and costs, the Affordable Care Act’s central planning has been a disaster. It makes no sense for politicians to double down, especially when they’re gambling with the livelihoods of American families.”

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