Increasing Losses of Health Coverage May Put Pressure on for Public Insurance

Janice Simmons, for HealthLeaders Media , May 5, 2009

With an estimated 2.4 million workers having lost their health coverage provided through their jobs since the start of the recession, is now the time to start talking about a public plan option? According to Senate Finance Committee Chairman Max Baucus (D-Mont), the answer is in due time.

"This is one of the 800-pound gorillas. Some say they will not support legislation without a new public insurance plan. I have told everybody that everything is on the table," Baucus said during a conference call introducing new reports from the Center for American Progress on the uninsured in the U.S.

But while "the public [plan] option is something I've kept on [the table], I've pushed it a little over on the side . . . We haven't reached that quite yet. I'm trying to gain momentum with other provisions," he said. "That's why I started with delivery system reform [at the first of three Senate Finance Committee roundtables on April 21]. But once we get to the public option, it's going to be a big debate."

The public plan option is on the minds of quite a few on Capitol Hill as seen last week when 16 Democratic senators—some considered more liberal and others more middle-of-the-road—sent a letter to Baucus and Sen. Edward Kennedy (D-Mass) of the Senate Health, Education, Labor and Pensions Committee whose committees have oversight on healthcare reform.

The senators, including Jay Rockefeller (D-WV), James Webb (D- Va), Sherrod Brown (D-Oh), and Robert Casey (D-Pa.), wrote that they supported a public plan option as "a core component of this reform .... There is no reason to believe that private insurers alone will meet the public purpose of ensuring coverage for all Americans at an affordable price for taxpayers."

In the meantime, the country is looking at escalating numbers of Americans losing their jobs and health coverage, with about 1.3 million of these losses occurring in the last four months. This boils down to about an average of 10,680 workers a day, according to the center's reports.

But attention also needs to be paid to the fact that many people who don't have health insurance do have a job: 65% of uninsured adults in U.S. are employed, said the center's president, and the Center for American Progress Action Fund President and CEO John Podesta.

"However, the connection between having a job and having health insurance is breaking down in part because more and more employers cannot afford to cover their workers. Since 1999, the average employer contribution to healthcare has gone up by over 119%—and even adjusted for inflation, it's up over 80%," Podesta said.

Over the same period, the percentage of Americans with employer-sponsored insurance has declined from 67% to 63%, and "things are getting worse," Podesta said. "The rising number of working uninsured is a disturbing undercurrent and has certainly be accelerated by the recession."

The reports note that all industries except four—health services, natural resources and utilities, mining and government—showed declines in their payrolls in the past 15 months.

Physicians can play a major role in addressing healthcare reform issues such as coverage, according to Vivek Murthy. MD, president and co-founder of Doctors for America. Murthy, a physician at Brigham and Women's Hospital in Boston, said at the teleconference that his year-old organization is not advocating a specific healthcare reform plan, "but we do think that a public plan is worth considering, and nothing should be take off the table at this moment."

"The key priority in whatever plan [that] is put forth is: does it really improve access for a patient and improve choice for a patient," he said. His group currently has nearly 12,000 supporters of healthcare reform nationwide.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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