Abstract
Given the close division of power in D.C., how might health reformers pursue their bolder aims? In particular, how might they pursue the robust public option that is a centerpiece of Joe Biden’s reform proposal? This ambitious plan, which would allow all Americans to enroll in subsidized public health insurance, is not in the cards right now. However, I argue for conceiving of it as an inspiring vision that can structure immediate initiatives designed to make its achievement more feasible. First, I explain just how far-reaching the mainstream vision of the public option now is. Second, I describe a self-reinforcing path to that endpoint that involves what I call “building power through policy”—using the openings that are likely to exist in the near term to reshape the political landscape for the long term. This path has three key steps: (1) pursuing immediate improvements in the ACA that are tangible and traceable yet do not work against the eventual creation of a public option; (2) building the necessary policy foundations for a public option, while encouraging progressive states to experiment with state public plan models; and (3) seeding and strengthening movements to press for more fundamental reform.
Contemporaneous and long-term effects of children’s public health insurance expansions on Supplemental Security Income participation
