After the 2016 election, I wrote a blog cautioning then President-Elect Trump and the Incoming Congress not to rush to “repeal and replace” the Affordable Care Act. I urged our nation’s elected leaders to proceed in a thoughtful way that reflected the trust the electorate had placed in them. I argued that they should work to repair the ACA rather than look to repeal it.
With the presidential primary season under way, the health care issue in the news now is Medicare for All. I agree with the proponents of Medicare for All that health care is a human right that is essential to our well being. I agree with the goal of universal coverage. Yet, I disagree that upending our current health insurance system and replacing it with a single government-run program is the answer.
Right now, about half of all Americans receive employer-sponsored health insurance, making it by far the single largest form of coverage in America. Yes, there absolutely are problems with high premiums and out of pocket costs. Still, according to multiple surveys, most people covered by their employers generally like their health insurance and want to keep it. There is no groundswell of employees across the nation clamoring to trade in their coverage for a government-run program.
Nor is there evidence that Americans want to pay more in taxes to fund a single payer program.
Historically, successful change in health care has come incrementally. We expanded health care access when the need, funding and political support aligned to enable us to do so. And we addressed those existing needs without threatening those who were already adequately covered.
The ACA succeeded because it built on and improved our current system. The ACA stopped discrimination based on gender and pre-existing health conditions. Critically, the ACA also created a funding mechanism for states to expand Medicaid to cover more low-income people and provided subsidies to help those with higher incomes purchase insurance through the individual marketplace or exchanges.
In New Jersey, the effect was powerful. Our uninsured rate dropped from 12 percent in 2008 to 7.7 percent in 2017 — the lowest on record.
The fundamentals of the ACA remain solid and can be improved upon to cover more people. We may not reach the 100 percent coverage that proponents say Medicare for All would provide, but we can create real and lasting improvements without risking all that currently works in our health care system.
Granted, the system today still does not work for everyone. In particular, for those over the age of 50 but under 65 — and who must purchase insurance on their own without a subsidy — premiums can be unaffordable. I would support an option for this group to purchase a plan from Medicare or Medicaid. Call it Medicare for All (Who Want It). We also need solutions for those who make too much money to receive Medicaid or subsidies but can’t afford to get the care they need because their out of pocket costs are just too high.
And we can continue to find ways to cover the six to eight percent of Americans who still fall through the cracks and remain uninsured. We could improve outreach for the ACA and make it easier for people to enroll. We could adjust the amount of the premium subsidies or income eligibility cut off points to get the balance right. These are modifications that would make our system work better but would not require substantial tax increases.
“Medicare for All,” just like “Repeal and Replace,” may sound like a bold plan of action, but when it comes to health care, steady forward improvement of the ACA, including options to buy-in to Medicare or Medicaid, will yield a stronger and more effective system for everyone.
This blog written by Linda Schwimmer was originally published on NJ.com. Join the conversation through the comments feature on NJ.com here.