National US health care plan, what does ‘public option’ mean?

Posted on March 29, 2010 by compassiontara at Bound, not Gagged

Thank you to Melora from SWOP-Boston for putting this all together.

Primary Source: TIME magazine
Secondary Sources:,,, various google searches (checking search lists for irregularities, will only site every source used upon request)


If you do not fall under one of the categories below, you will experience no change in coverage or costs. For the purposes of the following, Medicare means both Medicare, and Medicaid.

Have questions? Ask!

Have opinions? Dare to debate.

Effective 2010:

* Uninsured with pre-existing condition receive immediate coverage (though i have not yet put together HOW – it depends on a plethora of factors that vary from one individual to another including income, employment, and geographic.
* Uninsured and age 26 or younger are now approved to be covered by their parents’ insurance
* Insurers no longer allowed to deny care to a patient who becomes sick (currently private companies are able to suspend coverage of individuals who develop certain illnesses, despite having paid their premiums)
* Insurers no longer allowed to end coverage after a patient reaches a certain age (many companies will not cover you if you live past 80, for example)
* Insurers no longer allowed to deny coverage to children with pre-existing conditions
* Employers of small businesses to receive tax credits if they purchase insurance plans for their employees.
* Medicare prescription drug beneficiaries receive $250 as a stipend when they hit the doughnut hole.
* What is the doughnut hole? A rule in medicare part D prescription drug coverage that states that once Medicare has paid $2,700 in prescription drug coverage for an individual, they are then on their own to cover the full cost of prescription medications until they have reached $6,154 in prescription drug expenses.

Effective 2011:

* Insurers required to spend 80% of premiums collected on medical services.
* Medicare Prescription Drug Beneficiaries receive 50% the cost of prescriptions while in the doughnut hole.

Effective 2013:

* Medicare taxes on unearned income increase for individuals earning $200,000+/yr or families earning $250,000+

Effective 2014:

* Everyone must either be insured or pay a fine, whichever is less expensive. (the way the government will know whether you are insured is by making demonstrating proof of coverage a part of filing taxes.)
* Families earning less than four times the federal poverty level ($22,000 x 4 = $88,000) receive subsidies to help them cover the cost of insurance
* Public healthcare options provided by states (similar to the insurance already available in Massachusetts) become available to anyone in the country who does not have insurance coverage via either their parents, their employer, or medicare.
* Insurers officially banned from denying anyone with a pre-existing condition
* Insurers limited in their abilities to price coverage based on pre-existing conditions
* Employers of 50 or more people must provide coverage to their employees or pay a fine, whichever is less expensive.

Effective 2018:

* Insurers that bill individuals $10,200+ or families $27,500+ annually are subject to a 40% excise tax

Effective 2020:

* The doughnut hole is eliminated.

A small bit about forcing people to have insurance:

* The costs will be low (in MA current costs are about $25/month), and you get help if your family makes less than $88,000/yr.
* This process does effectively ensure that public option healthcare can remain affordable and available to those of us who are dying and need it, and helps support emergency care, which is the most expensive and the most used by the uninsured who wait until they’re on their death beds to seek medical assistance.
* You’ll be impressed how affordable it is for people as poor as us.

public option health insurance will bill on a scale according to income, not health status. private insurers will not be allowed to base prices on a patient’s medical status either. that was the main reason sited for why they pushed this bill so fast: so many people right now are sick and dying because they can’t afford health care.
however, there’s no way to know now what the exact numbers are yet, and this makes people uneasy. when it comes to costs, it’s still a couple years before the public option will be available, and each state will have its own variables that it has to grapple with in constructing their public option. While MA’s successful and extremely affordable public option healthcare (which began in 2006) will likely be a model for other states, it’s impossible to predict whether other states will be as generous with their benefits as MA.
this is an exact quote from TIME, which I take at face value based on the fact that the magazine is right wing and therefore has no motives to make the healthcare bill look good. the sources cited for the article from which i quote directly are the Congressional Budget Office, US Census Beaureau, Kaisser Family Foundation, Patient Protection and Affordable Care Act, and Commonwealth Fund:

if you [have a pre-existing condition and] plan to buy your own coverage, you will be able to get it from any insurer selling in your area, and you will pay the same as anyone else in your age group. insurers won’t be able to place annual or lifetime limits on your coverage, and regulations will limit your out of pocket spending. 36% of Americans were turned down or charged higher premiums because of pre-existing conditions in 2007.

Again, thank you to Melora of SWOP Boston for putting this all together for us, and for helping make it easily digestable, and for Time Magazine for being such a great source of information.

So, what are your thoughts, now that we can understand it? For or against, call or email your congressman and senators and let them know! Personally I’m for it now. I think it could go a lot farther, but this is way better than what we currently have!!

update (3/29/10 8:20PM PST): fixed up the bit about forcing people to have insurance and costs, the original was by me (Tara) and this new update is by Melora, because she’s so much smarter then I am about this stuff!

update (3/3/10 2:20PM PST): Some of this may be incorrect, we are working on resolving these issues.. sorry! a 2,000+ page document boiled down to something someone can understand is hard!!!

update (3/30/10 5:48PM PST): Ok, apparently nobody knows what’s up with the above $$ part, so take all of the stuff like this with a grain of salt, a HUGE grain of salt. If and when congress/senate ever make up their minds, then we’ll know. Right now that’s the big debate they are fighting over, so if you feel it should be one way or another, now is the time to contact our congress and senate. The rest of the article stands as fact for now.


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