The Honorable Patty Murray
Chair
Committee on Health, Education, Labor, and Pensions
U.S. Senate Washington, D.C. 20510

The Honorable Frank Pallone, Jr.
Chairman
Committee on Energy and Commerce U.S. House of Representatives
Washington, D.C. 20515

Dear Chair Murray and Chairman Pallone,

We are pleased to submit this response to your request for advice on how to design a health
insurance “public option.”

On behalf of our organizations and the millions of Americans we represent, we strongly applaud the
goal of giving patients more access to better care at lower cost.

But just as strongly, we oppose the idea of a “public option” and any other “reform” that would
dramatically expand government intervention in Americans’ health care. Instead, we recommend a
“personal option” that gives Americans more choice and control over their own health care.

If the pandemic has taught us anything, it is that the private sector is best equipped to address this
country’s critical health care needs. Creating additional layers of government will only make things
worse.

A better term for a public option would be a “government option.” Why? Because regardless of how
it’s designed, it would lead to a single-payer system where every American’s health care is subject to
the control of a massive government bureaucracy and inevitable government rationing.

A so-called “public option” would kick millions of Americans off their health plans, crush taxpayers
and the economy, impoverish doctors and hospitals (especially in rural areas), and leave patients with
little real choice when it comes to obtaining the coverage they want and need.

Americans do not want a complete government takeover of health care. They want targeted,
personalized solutions that fix what’s broken in our health care system and keep what works.

It all comes down to trust. Who do we trust with our health care? The government? Or our own
doctors? Americans resoundingly say, “Our own doctors.” It’s troubling – and telling – that
supporters of a public option have never settled on a single definition for the term “public option”:

a) In some proposals, it means a government-sponsored health plan that “competes” with
private insurers while also regulating them. (For example, a plan introduced by Senators
Bennet and Kaine.)

b) In other proposals, it means a standardized health plan that all insurers must offer, and all
doctors and hospitals must accept, at government-dictated prices. (For example, a law
enacted in Washington State.)

c) And in still others, it seems to refer to a massive expansion of existing, government-run
health insurance programs and/or more insurance regulations. (For example, proposals
urged by some Connecticut lawmakers.)

Since the Affordable Care Act took effect in 2014:

• health insurance premiums have doubled,
• deductibles have tripled,
• access to the best doctors and hospitals has diminished, with coverage choices falling by a third or more, and
• rural hospitals have been closing at an alarming rate.

Would a government option reverse any of these negative trends? It seems unlikely. For example,
since Washington State implemented a “public option” in 2019, premiums have actually gone up by
30 percent.

Would a government option guarantee us access to our preferred doctors and hospitals? It seems
unlikely, since providers are likely to be paid less than they are today, which is the most basic
assumption of the “public option” concept.

The results of a reduced provider payments could be devastating. Currently commercial health
insurance plans pay rates significantly more generous than those paid by government plans like
Medicare and Medicaid. A 2019 analysis found that implementing a government option that pays
hospitals at rates equal to Medicare’s could place as many as 55 percent of hospitals in rural areas at
high risk of closure. That’s a potential death sentence for as many as 1,037 hospitals across 46 states.
What will happen to people living in those remote communities?

A Better Way

Happily, there’s a better way – a “personal option,” a set of smart, sensible reforms that empower
patients to act as true consumers through greater choice, competition, and price transparency.

A personal option means giving all Americans have the choice and control they want, with the
quality they deserve, at a price they can afford, from the medical professionals they trust.

What does it mean, more specifically?

• It means letting patients have access to direct primary care practices, which offer access to your preferred doctors 24/7 at a low monthly rate with no insurance-company middlemen.
• It means letting doctors and nurses treat patients across state lines, in-person and via telehealth.
• It means removing local bureaucratic barriers, so new hospitals can open, and existing hospitals can expand and add new high-tech equipment, without a government permission slip.
• It means giving families more affordable insurance options including personally tailored coverage that meets their actual needs, and personally owned, portable coverage that’s always there for them when they get sick or change jobs.
• It means enabling every American to obtain deep price discounts on medical purchases using a personally owned, tax-free health savings account (HSA) and/or workplace health reimbursement arrangement (HRA), as well as dramatically liberalizing how much people can contribute to their accounts, what they can spend the money on, and the kinds of insurance coverage they must have to qualify for an account.
• It means moving away from one-size-fits-all mandates that don’t work and allowing more regulatory decisions to happen at the local level.
• In short, it means giving families more price transparency and lower costs – and greater peace of mind – through markets, not mandates.

A new survey shows Americans want these things. In fact, seven in ten voters said they prefer a
personal health care option over government takeover proposals like the public option or “Medicare
for All.” That includes 68% of Independents and 72% of women. A majority of voters, 53%, reject a
complete overhaul of the health care system, while just 16% support taking that approach via the
public option or “Medicare for All.” It’s clear; voters want to keep what works for them and fix
what’s broken.

For all these reasons, we strongly encourage you to reverse course and “just say no” to a
government health care takeover and a government “option.” Instead, let’s work together to give
every American a personal option.

Sincerely,

Brent Wm. Gardner
Chief Government Affairs Officer
Americans for Prosperity

Thomas Schatz
President
Council for Citizens Against Government Waste

Bethany Marcum
CEO
Alaska Policy Forum

Tarren Bragdon
CEO
Foundation for Government Accountability

Grover Norquist
President
Americans for Tax Reform

Grace-Marie Turner
President
Galen Institute

Andrew F. Quinlan
President
Center for Freedom and Prosperity

Naomi Lopez
Director of Healthcare Policy
Goldwater Institute

James Taylor
President
Heartland Institute

CL Gray, MD
President
Physicians for Reform

Mario H. Lopez
President
Hispanic Leadership Fund

Jenny Beth Martin
Honorary Chairman
Tea Party Patriots Action

Alfredo Ortiz
CEO
Job Creators Network

Byron Schlomach, Ph.D.
Director
1889 Institute

Seton Motley
President
Less Government

James L. Martin
Founder/Chairman
60 Plus Association

Charles Sauer
President
Market Institute Foundation

Saulius “Saul” Anuzis
President
60 Plus Association

*Organizational affiliation listed for identification purposes only.