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Democrats pitch Medicaid ‘public option’ for states

Progressive Democrats, more confident that the legislative threat to the Affordable Care Act has passed, are adding a new bill to their stack of health-care legislation — one that would allow people to buy into a Medicaid “public option” in their states.

The State Public Option Act, sponsored by Sen. Brian Schatz (D-Hawaii) in the Senate and Rep. Ben Ray Luján (D-N.M.) in the House, would expand Medicaid from a program available only to Americans at or slightly above the poverty level, to a universal program anyone could buy into. Already, 18 Democrats in the Senate have co-sponsored the bill, including Sen. Bernie Sanders (I-Vt.) and most of the party’s potential 2020 presidential candidates.

“Medicaid itself took awhile to catch on in every state; it wasn’t until 1982 that every state participated,” said Schatz in a joint interview with reporters yesterday. “Over time, as the politics settle down, states will avail themselves of this opportunity.”

Schatz had worked on the bill for months, inspired — as he told Vox in August — by the surge of public support for the Affordable Care Act’s Medicaid expansion that followed Republican attempts to repeal “Obamacare.” Over the summer, before Republicans resurrected (then fumbled) their repeal attempt, Nevada’s Democratic-controlled legislature passed a bill that would have made Medicaid universal; it was vetoed by Gov. Brian Sandoval (R-Nev.). But the Nevada experience resonated on the left.

With support growing for universal health coverage, just what does "single-payer" mean? Here's the breakdown. (Video: Jenny Starrs, Danielle Kunitz/The Washington Post, Photo: Andrew Harrer/The Washington Post)

Even in deep blue states like Vermont and California, attempts to remake the health-care system with single-payer plans have been stymied by cost and complication. The Schatz bill takes the Nevada idea nationwide.

“Our bill builds on a system that already works — a system that is already in place in every county in every state in the country; and a system that has built-in efficiencies,” Lujan said at the joint interview and in a statement.

Like Sanders’s universal Medicare bill, the Schatz legislation does not contain taxes to pay for its cost. Like Sanders, Schatz suggested analysts could get cracking. “That includes getting a CBO score; that includes getting a pay-for,” he said.

In September, Republicans requested a CBO score on Sanders’s legislation. It has not yet been released.