For Democrats, a stepping stone to common ground on health care

WASHINGTON — Bernie Sanders’ ‘‘Medicare for all’’ plan seems even less likely now that he’s all but out of the race for the Democratic presidential nomination, but there’s a way that he and Hillary Clinton could still find common ground on health care.

It would let Democrats rally around the cause of government-run health care without committing to the politically perilous course of trying to change the entire US system at once.

The idea is a ‘‘public option’’ for states to set up their own insurance plans that compete against private industry.

Sanders helped to pass the federal legislation that would allow it, and Clinton, the presumptive Democratic presidential nominee, says if elected she would work with interested governors to implement it.


In Sanders’ home state of Vermont, a long campaign to put the health system there under state control hit a dead end after cost projections came in alarmingly high. But the idea of a smaller step that would let the state set up a competitor to private insurance could catch on.

‘‘That’s something that I think Vermonters would be extremely interested in pursuing,’’ said Lawrence Miller, a top health-policy aide to outgoing Governor Peter Shumlin, a Democrat. ‘‘A public option, I think, is a very different conversation’’ than a so-called single-payer system run by government.

It remains unclear how many states might be interested in a public option, which would probably trigger a sharp backlash from the deep-pocketed insurance industry. This fall Colorado voters will decide on an even more ambitious change, a state-run system that would cover most residents.

By supporting health care activism at the state level, Clinton may be able to broaden her appeal to liberals energized by Sanders’ idealistic campaign.

Incremental improvements to President Obama’s health care law that Clinton has proposed aren’t fulfilling to liberals, said Robert Blendon, a professor at the Harvard T.H. Chan School of Public Health, who follows public opinion on health care.


‘‘What’s exciting to them is not just adding benefits,’’ he said. ‘‘It’s offering some sort of public alternative to current private insurance.’’

The idea also could give Clinton a way to change the conversation if, as expected, a wave of sharp premium increases hits the health law’s insurance markets later this summer and fall.

The legal vehicle for a state public option is already in place at the federal level, a section of Obama’s health care law that allows waivers for state innovation.

States can begin applying for the waivers Jan. 1, right around the time a new administration takes over. If the federal Health and Human Services Department approves, states can take federal money used for coverage expansion and spend it their own way, so long as they don’t run up the federal deficit, leave more residents uninsured, or slash benefits.

The provision’s author, Senator Ron Wyden of Oregon, said Sanders was ‘‘very constructive and very supportive’’ in getting it into law. At the time of the 2009-2010 health overhaul debate in Congress, a state waiver was seen as a potential vehicle for a government-run system in Vermont.

But Wyden said the concept is ideologically neutral, so that Republican and Democratic governors can seek waivers to test competing ideas.

Both Clinton and Sanders have previously supported a public insurance option at the national level. But opposition from moderate Democrats kept that proposal out of the final health overhaul law.


Sanders now is focused on putting his stamp on the Democratic platform, hoping to steer the party to the political left.

His campaign says he’ll keep pushing for his national health care plan, and won’t settle for state experimentation as the last word.

However, policy director Warren Gunnels said Sanders would definitely support a state public option.