By Jill Zorn
Anyone who cares about access to health care for all Americans is working hard.
Federal advocacy is required to save the Affordable Care Act (ACA) and prevent Congress from repealing the law. And we must act at the state level, too.
In Connecticut we are working to mitigate the fallout from what is happening in Washington, fighting to protect people should the ACA continue to be undermined. The Protect Our Care CT Campaign is shaping up as a focal point for state-level organizing and advocacy.
In addition to playing defense, we also must take positive steps to improve the ACA and move further along the path to true universal health care.
Common Sense Solutions
In the past, major pieces of health care legislation, like Medicare, have been revised repeatedly over the years to fix unanticipated problems and make needed adjustments. A good recent example is the passing of Medicare Part D legislation in 2003 which funded prescription drug coverage for Medicare recipients, coverage that wasn’t included in the original law when it passed in 1965.
The ACA is far from a perfect law. But political gridlock in Washington has prevented ACA repair from occurring. Even worse, Republicans have spent years actively sabotaging the law.
But it’s important to remember that the ACA actually could be improved.
Sabrina Corlette, an expert from Georgetown University’s Center on Health Insurance Reform, makes several suggestions in her March blog post, Fix it, Don’t End it Common Sense Prescriptions for Individual Market Stability. Possible solutions include:
- Improve affordability by increasing eligibility for subsidies or tying subsidies to more generous plans (gold plans rather than silver plans)
- Increase funding for outreach and enrollment
- Provide better protection for insurers if their enrollees end up being sicker than anticipated
What About a Public Option?
One of Corlette’s suggestions is to provide a “fall back plan”, to protect states that are down to only one or two competitors in their marketplaces.
This suggestion sounds quite like the idea of offering a public option. This piece in Quartz about “what Congress should actually do” explains:
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….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.
Another way to think about a public option would be to raise Medicaid eligibility income levels.
Unfortunately, Connecticut is in the process of doing just the opposite. We already lowered eligibility from 201% of the federal poverty level (FPL) to 155% FPL. Now the Governor’s budget proposes to lower eligibility again to 138%, the federal floor required by the ACA.
A recent study published by Connecticut Health Foundation shows that lowering income thresholds leaves many people uninsured. Our foundation and many other advocates in the state are fighting to stop this cut.
Allowing people who are 55 or 60 to choose a Medicare plan would be another creative way to provide a public option to more people. As the Quartz article points out, this could be a “win-win” policy:
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.
Medicare for All
In the midst of the repeal and replace battle, there is a renewed call for Single Payer/Medicare for All. Many individuals and organizations are joining together under the banner of the Campaign for Guaranteed Healthcare.
The single payer bill in the House – HR 676, Expanded and Improved Medicare For All Act – now has a majority of House Democrats as co-sponsors. Conspicuously absent are any representatives from Connecticut, the “Insurance Capital of the World”. While HR 676 may be a long shot, it sets out a very clear vision for where we need to be.
A Hard Road Ahead
The current fight has clarified the thinking of a majority of Americans that government has a responsibility to guarantee health care for all. But how we will get to universal health care will certainly involve incremental steps.
Priority one is to stop our country from going backwards. The sabotage of the coverage of millions of people through passing a repeal bill or through active undermining and purposeful inaction must be stopped.
But equally important is to make sure we move forward toward the ultimate vision of quality, affordable health care for all.