Republicans’ failed attempt to repeal and replace the Affordable Care Act in the US has exposed a wide gulf between the GOP’s critiques of the law and the “solutions” they are offering. GOP leaders from president Donald Trump to Senate majority leader Mitch McConnell have blasted Obamacare for imposing high costs on enrollees and for leaving too many Americans uninsured—and there is truth to these critiques. But the Republicans’ replacement bill did absolutely nothing to help on either front. Indeed, it actively made both coverage and cost significantly worse.
Even if the GOP isn’t interested in proposing serious solutions, we shouldn’t lose sight of the fact that there are effective and attainable ways to address the problems that still ail health care in the US. Here are a few ideas to start:
Let people get Medicare before retiring. Medicare is an overwhelmingly popular program among seniors, and the government should give more people access to it. One way to do this would be to lower the eligibility age to 55 or 60, giving those nearing retirement the choice to opt out of private insurance and buy into Medicare instead.
This change would expand good coverage to those who need it most. And financially, giving people nearing retirement age access to Medicare is a win-win. It would help shore up Medicare’s finances by enrolling people who are younger and healthier than Medicare’s current population. At the same time, it would pull some of the oldest and costliest individuals out of the private insurance market, lowering costs for everyone else.
Allow more people to sign up for Medicaid. Of the 20 million people insured under Obamacare, more than half gained coverage through the law’s Medicaid expansion, which extends coverage to people earning up to 138% of the poverty line.
But 19 holdout states have refused the offer of free money from the federal government to expand Medicaid. This is a stark reminder of why we should just let the federal government assume full control over Medicaid, which is currently run jointly with the states. People would no longer be at the mercy of state governments, and states would no longer bear the budgetary burden of helping to finance the program.
We could also increase the income cutoff to give more people access to Medicaid. One of the unintended side effects of Obamacare has been a bad case of Medicaid envy. People earning incomes just above the Medicaid cutoff must purchase coverage on Obamacare’s marketplaces, where they may only be able to afford complex plans with high deductibles. Meanwhile, their neighbors earning less get Medicaid coverage with minimal or no out-of-pocket costs. This strikes many as unfair. Allowing people with slightly higher incomes to opt into Medicaid coverage instead of private insurance could help fix this problem
Create a public option. During the drafting of Obamacare, the proposed public option for health insurance was beloved by progressives, but ultimately defeated by Democratic centrists. Yet the law’s ensuing implementation has only heightened the need for a public option—that is, a government-run health-care plan. More and more private insurers are declining to sell on the law’s marketplaces, leaving much of the country with virtually nonexistent choice and competition.
Universal health care should not depend on the business decisions of private corporations. At minimum, we should provide a public option as a fallback in those parts of the country that have too little competition among private insurers. This is an idea that had bipartisan support during the Obamacare drafting process—and one that Obama himself recently resurfaced.
But ideally, we should give everyone the choice of a public option. This would help consumers by spurring competition and thereby lowering costs—particularly if the public option could offer Medicare’s low prices to doctors and hospitals.
Increase subsidies for people buying private insurance. Obamacare provides subsidies to help people afford insurance on its marketplaces. But even with these subsidies, purchasing coverage can still be a stretch for many. Inadequate subsidies have frustrated consumers, many of whom have only been able to afford plans with extremely high out-of-pocket costs.
Increasing the generosity of the subsidies would ease this financial strain and allow more people to afford better insurance. Larger subsidies would also be a stronger carrot to nudge more young healthy people into the market, helping to lower the overall cost of insurance.
Use the power of government to lower health-care prices. The US has some of the highest health-care costs in the world, which inflates the health insurance premiums paid by consumers. Getting costs under control requires government intervention. Medicare very nearly had the power to regulate the prices it pays for health-care services—a power that was removed right before it became law. We ought to seriously consider whether that idea’s time has come.
At the very least, we could allow Medicare to negotiate with drug companies instead of just paying whatever they charge—a popular pledge from Trump on the campaign trail that is nowhere to be found in the GOP’s health-care bill.
We could also empower more of Obamacare’s marketplaces to negotiate with insurance companies. California’s marketplace leverages its platform power to actively haggle with insurers to get a better deal for consumers. That’s partially why average premiums have increased much less in California than they have in the rest of the country.
Each of these reforms have been promoted by progressives to offer consumers better coverage at lower cost. Yes, they would cost the government money. But it’s worth taxing the well-off to extend quality affordable health insurance to everyone. The Republicans’ repeal bill does the exact opposite: eviscerating health care for the vulnerable for the sake of slashing taxes on the rich.
There are indeed steps we should take to improve health care in the US. But none of them involve the smoke and mirrors peddled by the GOP. If you really want to turn American health care into “something terrific,” don’t look to the right—look left.