Healthcare reform finally moved from the backburner to front and center recently when Democratic frontrunner Hillary ClintonHillary Diane Rodham ClintonCohen once teased Hillary Clinton about going to prison. Now he's been sentenced to 36 months The Hill's 12:30 Report — Cohen gets three years in prison | Fallout from Oval Office clash | House GOP eyes vote on B for wall Contest offers 'Broadway play and chardonnay' with Clinton MORE gingerly called for a public option during a Virginia campaign stop.

The truth is a major crisis has been brewing among private insurers, always the linchpin in the Affordable Care Act (ACA), and recent financial struggles prove a robust discussion on healthcare must be central to the 2016 presidential debate.

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Clinton needs go even further: Her “option” only allows Americans 55-64 to buy into Medicare, but all ages need a viable public choice and should be able to buy into Medicaid or Medicare.

Two stunning announcements prove why.

Blue Cross Blue Shield’s parent company HCSC announced a $1.5 billion loss on insurance exchanges in 2015, pulling wide network offerings in their two biggest markets, Texas and Illinois, raising rates everywhere. United Health Care announced it will exit most state exchanges by 2017. Both companies attributed large losses to the unpredictable costs of insuring the previously uninsured.

These startling private sector retrenchments should concern anyone who thinks the insurance industry can provide the entire solution. One study found 2.9 million Americans will be left with only one or two choices on their state exchanges when United Health Care exits. Blue Cross Blue Shield pulled out of New Mexico’s exchange altogether because the state wouldn’t approve rate increases. Yet, there remains a strong role for private insurers, as employer-sponsored health plans netted HCSC $932 million in 2015.  

One wrinkle in this complicated story deserves note: Congressional Republicans scuttled plans to incentivize private firms in taking on the unknown, and largely unknowable, risk of covering 46 million uninsured Americans now that it’s no longer legal to deny coverage based on pre-existing conditions, a move 82 percent of Americans supported. 

Experience with other public insurance products has shown us things we didn’t know before: States that expanded Medicaid have already demonstrated better outcomes than states that haven’t, including higher rates of coverage and increased access to prescription medications for low-income families. These states saved money through reduced spending and uncompensated care for the uninsured, and gained tax revenue collected from providers. Medicaid expansion also reduced financial strain on previously uninsured Americans who struggled to pay medical bills.

To be sure, more than 30 million Americans still don’t have health insurance, and an insurance card is not the same thing as health care access. Increasing coverage is a critical first step. Among the insured,  rates of medical debt have decreased, as have rates of delaying care, according to The Commonwealth Fund. The industry as a whole is moving toward patient centered, value-based  care that lowers costs by keeping people healthy.

As a public health professional who always supported a comprehensive public option, I vividly remember a friend working behind the scenes in 2009, telling me a public option wasn’t politically viable. He tried to console me with historical parallels, in the way only policy wonks can: “When FDR passed Social Security, it only covered white men. This is the first draft. We have to get something passed and then we can tweak it later.”

The time for tweaking has come.

The government has to do more than incentivize insurers. Meanwhile, another wrinkle deserves note. GOP frontrunner Donald TrumpDonald John TrumpActivists highlight Trump ties to foreign autocrats in hotel light display Jose Canseco pitches Trump for chief of staff: ‘Worried about you looking more like a Twinkie everyday’ Dershowitz: Mueller's report will contain 'sins' but no 'impeachable offense' MORE’s health care platform wants to abolish Obamacare in favor of free market principles, but his goals are the same as ACA: “Broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.” 

If Clinton embraced a comprehensive public option as recent polling suggests Americans are more open to it just might prove a comparative advantage.


Stephanie E. Farquhar, Ph.D., is a Dallas Public Voices participant and public health executive.