Some Republicans Are Just Fine with a Public Option

The idea of a government run health insurance plan, competing with private insurers, has reentered the public discourse. Hillary Clinton has recently revived the notion and so has President Obama. When the Affordable Care Act was enacted this was a feature the left had to abandon in order to get moderates to vote for Obamacare. Now they want another bite at the apple.

Is there any reason to think that the proposal will attract more backing today than it did six years ago? Indeed it might. Turns out that some Republicans may be willing to come on board, provided the public option is Medicaid.

Paul Ryan’s Task Force on Health Reform is an example of a limited step in that direction. Under the proposal, certain near-poverty families would be able to “buy into” Medicaid by paying a small premium. At the same time, people who are eligible could get premium support from Medicaid if they join an employer’s plan instead. People who obtain insurance in the individual market could get both premium support from Medicaid and a federal health insurance tax credit to subsidize their choice.

So as not to mislead, the Ryan task force report does not actually describe these features as public/private competition. But such competition is implicit in what the report proposes—even if the writers don’t seem to be focused on it.