What We Learned in 2021: Lawmakers and Voters Prefer Building on What’s Working in Health Care

WASHINGTON – As 2021 comes to an end, what we’ve learned this year is that many lawmakers and a majority of voters prefer building on what’s working in health care rather than starting over with a government-controlled health insurance system. 

At the beginning of the year there was speculation that the Administration and Congress would introduce government-controlled health insurance proposals, such as the public option: 

• “Fresh off securing the first big upgrade to Obamacare since its 2010 passage, Democrats are eyeing a much heavier and politically riskier lift: creating a government-run public health insurance option. President Joe Biden campaigned on the idea, touting it as an achievable reform that would bring down costs without upending private health insurance.” (Politico, 3/16/21) 

As the year progressed, conversations on how to improve access to affordable, high-quality health coverage centered around building on what’s working in health care. As policymakers debated which health care provisions should be included in the social spending bill, many lawmakers made it clear that improving our current system is the priority, rather than starting over with proposals like the public option: 

• Speaker Nancy Pelosi has long been a key figure in working to shore up current health care law. In 2019 Pelosi said, “We all share the value of health care for all Americans — quality, affordable health care for all Americans. What is the path to that? I think it’s the Affordable Care Act.” (Washington Post, 09/25/21) 
• Sen. Joe Manchin has been clear that the costs of the public option cannot come at the cost of our current health care system: “I, for one, won’t support a $3.5 trillion bill, or anywhere near that level of additional spending…This is even more important now as the Social Security and Medicare Trustees have sounded the alarm that these life-saving programs will be insolvent and benefits could start to be reduced as soon as 2026 for Medicare and 2033, a year earlier than previously projected, for Social Security.” (Wall Street Journal, 09/02/21) 
• Rep. Abigail Spanberger has said: “My priority is ensuring the ACA exchange programs and Medicaid expansion—that those valuable resources continue to be available for America’s working families.” (Wall Street Journal, 09/08/21) 
• Rep. Susan DelBene, when asked how she felt about potential health care provisions in the reconciliation package such as adding a public option, said: “The top priority that I have is making sure that we build on the Affordable Care Act…That’s a top priority of mine [and of the] New Democrat Coalition, where I serve as chair.”  (Med Page Today, 09/09/21) 

Polling throughout 2021 shows most Americans favor building on what’s working in health care, instead of implementing costly proposals like the public option, Medicare at 60, and Medicare for All: 

• The latest edition of Voter Vitals, a nationwide tracking survey, found that 65 percent of voters prefer building the current system rather than creating the public option or opening up Medicare to younger Americans. (Voter Vitals, 12/6/21) 
• Additionally, Voters prefer to build on what’s working in health care by providing subsidies for those in states that did not expand Medicaid to purchase coverage in the existing marketplace over creating a new government-run insurance plan. (Voter Vitals, 12/6/21) 
• A health tracking poll conducted by Kaiser Family Foundation shows favorability for our current health care system is at an all-time high. The poll also shows that favorability increased as lawmakers built on our current system to lower costs and expand access to care. (Kaiser Family Foundation, 10/15/21) 
• Polling from Morning Consult and Politico found most Americans approve of our current health care system and the majority also believe our current system should be expanded on in the future. (Morning Consult, 06/21/21) 

Federal data also shows that building on the current system is working: 

• Almost 4.6 million Americans have enrolled in health insurance coverage through the federal and state exchanges for 2022 and twenty percent of those are new enrollees. (CMS, 12/9/21) 
• Data from the U.S. Department of Health and Human Services shows that four out five people have access to health insurance plan for $10 or less per month. (Department of Health and Human Services, 11/1/21) 
• Kaiser Family Foundation’s analysis found that expanding our current system is helping more Americans gain access to coverage through Medicaid and CHIP enrollment. Specifically, “More than a quarter or 7.0 million of the total 27.4 million nonelderly people who remained uninsured in 2020 are eligible for Medicaid or CHIP.” (Kaiser Family Foundation, 11/18/21) 

Building on and improving what’s working in health care is the future of health care reform and the most efficient way to ensure Americans have access to the affordable care and coverage they deserve. As we move into 2022, lawmakers should focus on building on what’s working, not starting over with unaffordable, government-controlled health insurance systems. 

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