This fall, I heard Hannah Pingree ’98 speak at the University Club in Providence during a fundraising stop on her Maine gubernatorial campaign. One of the points Pingree discussed and has highlighted throughout her campaign is a bold new framework for health policy. In the face of ever-increasing insurance premiums, her proposal would establish a state-backed public health insurance option, which would bolster competition in the insurance market, support underinsured populations and realign market incentives toward patient care rather than shareholder returns. This plan presents a competitive option that will hold corporate insurance companies accountable for their improper conduct and monopolistic practices, setting a blueprint that should serve as inspiration for states across the country. Brown — given its influence in the state and its unique affiliation with Brown University Health, formerly Lifespan, a major health care provider in the state — should lead the push for a Pingree-esque health care solution in Rhode Island.
Health care premiums have exploded in recent years, and under the most recent failure to fund expanded Affordable Care Act subsidies, premiums will nearly double for some Rhode Islanders. Meanwhile, health insurance companies are attempting to offload unprofitable insurees to maintain profit standards. Maine faces similar pressure. In practice, Pingree’s policy would allow residents of Maine to purchase their health care plan directly from the state, regardless of their age, income and employment status.
The common progressive answer to the poor state of health care in our country is to champion Medicare for All, which extends Medicare benefits to all Americans rather than only those over 65 years old. Although this expansion should be policy makers’ ultimate goal, in this current political climate — where systemic change at the federal level feels impossible — we must find ways to innovate at the state level to help fix the issues our congress refuses to address. While Pingree’s proposal would not dismantle Maine’s private insurance market, it would introduce a structural alternative rather than simply layering additional subsidies onto an already expensive system.
This public option would inject much needed competition into a market where industry giants have relied on their stature to coerce market share. Insurance giants are able to maintain their dominance over the market because their models require a critical mass of people to work. States have this competitive advantage, as they can insure broad pools of enrollees due to a large public workforce. Larger pools of enrollees spread risk across a broader population, which helps support insurees who may require more expensive care.
In Rhode Island, the government employs nearly 60,000 people — a sufficient pool of rate payers to take on the risk of providing insurance for individual enrollees across the state. Rhode Island’s small size may actually make this even more feasible, as centralized administration and a concentrated labor base make coordination more manageable. In this way, the state’s existing employment structure provides a built-in foundation for launching and sustaining a public health insurance option.
Brown can advocate for a similar state-level public insurance option in Rhode Island. As a close affiliate of the state’s largest hospital system and one of Rhode Island’s largest employers, Brown occupies a unique institutional position that connects health care provision and economic influence. The University has a direct interest in how health care is financed and delivered to Rhode Islanders. Further, Brown’s School of Public Health already has significant practice aiding the implementation of sensible public health policy in state houses across the country.
Brown’s identity as a policy pioneer and leverage as an economic stakeholder give it the opportunity to demonstrate the feasibility and value of such a system. Brown’s lobbying budget has ballooned — this power could be wielded to make a case for this state-backed health care plan to the state Legislature’s Health and Human Services Committees or the governor’s office. By advocating for a policy of this type, Brown would make considerable strides in advancing affordable insurance outcomes for surrounding communities — contributing to the University’s stated priority of community engagement.
Pingree’s plan lays out a concrete vision for how we can work within our current systems to create a new health insurance paradigm that could fundamentally change the relationship between Rhode Islanders and their insurers. A world where health care is driven by doctors and patients, not for-profit insurance adjusters, is within reach. We can prove that government administration of health care can be affordable and effective, paving the way for a national single-payer program. We don’t have to settle for hollow insurance plans that over charge and under deliver. Under this new policy framework, Rhode Island and states across the country could change the trajectory of American health reform from federal gridlock to state-led innovation.
Tommy Leggat-Barr ’28 can be reached at thomas_leggat-barr@brown.edu. Please send responses to this column to letters@browndailyherald.com and other opinions to opinions@browndailyherald.com.
