It could mean health insurance for 4 million low-income Americans, but somebody needs to demand that it happen.
. Although neither the administration nor Democratic leaders are focusing on a large public option right now, there is serious discussion of creating some kind of scaled-down version ― basically, a new program that looks like Medicaid ― that would be open only to low-income people in non-expansion states.
Either policy approach would involve its own set of tradeoffs and complications. Creating a new public option, even one targeting only the Medicaid gap, would require creating a whole new administrative apparatus. Opening subsidized plans on HealthCare.gov would be more straightforward, but it would cost more per person.
Especially in more conservative states where officials were never that enthusiastic about Medicaid in the first place, it’s easy to imagine them dropping their plans and handing the whole thing over to the federal government. Depending on program design, that could mean switching people now on Medicaid into private insurance plans that, in the view of many advocates, provide vulnerable Americans with inferior, less reliable coverage.
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