The debate over the public health insurance plan (public option) has occupied much of the healthcare reform discussions over the last six months. A public health insurance plan is a government-run plan that is similar to Medicare but for all ages.

When the Senate Finance Committee passed its healthcare proposal last month, many people were disappointed that it did not include the public option. However, when the House approved its final bill last week, the public option came back to life.

Recent numbers released by the CBO (Congressional Budget Office), a non-partisan economic analysis organization, estimate that by the time the public plan is fully phased in 2019, only 2% of people under 65 (six Million people) would sign up for the plan. That is, if a final healthcare is passed and if it looks anything like the House bill.

To start with, the public plan would be available for only 30 million people under the House Bill. Most other people would stick to their employer-sponsored health insurance plans, while low-income people would be covered under Medicaid expansions

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The 30 million are the people who buy coverage on their own or work for small companies. They would have access to the public option under new insurance exchanges (insurance exchanges are settings where the public plan and the private insurance plans would be brought together to compete, so individuals and small companies can shop around, compare prices and coverage, and select a plan). But even among these 30 million, only the least healthy six million would be truly attracted to the public plan. These are the people with several medical problems who would mainly be interested in the public plan’s relatively unrestricted access to specialists and services.

The reason why the plan would be attractive to only a small number of people, according to the CBO, is that it would cost more than existing private plans. That is a very surprising finding, given that the public plan was originally touted as a cheaper alternative that is going to increase competition and keep the private plans honest. It was thought that since a public plan wouldn’t have to pay high salaries and wouldn’t be under pressure to make profits, like the private plans, it would be cheaper and would save people money. However, the reality is the public plan would have to negotiate rates with doctors and hospitals, just like the private ones do.

It is also important to note that the House Bill includes a provision that allows states to opt-out of the public health insurance plan, meaning that the numbers could be even lower than 2%. After months of intense arguments, fuss, and back-and-forth accusations, it is starting to look like the debate over the public plan has been much ado about nothing!