The End of ObamaCare: Just the Beginning of Better Health Care

December 18, 2013

It should be acknowledged that most Republican-sponsored bills in Congress and health reform proposals advanced by market-oriented policy organizations have lacked necessary details, conceptual depth and compelling themes. Rather than just pointing to everything that is wrong with the Affordable Care Act (ACA), we need to flesh out a clearer path to a better future, says Tom Miller, a resident fellow at the American Enterprise Institute.

Far too many health policy reform proposals focus narrowly on who gets additional health insurance subsidies and how large they might be, or how the real costs of health care can be hidden and shifted to other parties. They also lack confidence in the ability of most health care consumers to make good decisions for themselves.  So what should we do instead?

  • First, allow willing parties to find each other in more transparent and accountable marketplaces. Dial back the ACA's dense set of counterproductive benefits mandates and insurance price controls.
  • Second, replace the unpopular and ineffective individual mandate to purchase Washington-approved insurance with new incentives to maintain continuous coverage instead. Individuals who stay insured would be assured of guaranteed renewability without new health-risk rating, plus protection against exclusions for pre-existing health conditions. Similar guarantees already existed for the employer group market under federal law almost 14 years before the ACA was ever enacted. They should be extended to the individual insurance market.

What about the much smaller number of Americans who might nevertheless be at risk of being left behind? Greater reliance on state-administered high-risk pools that are more effectively financed (with significant federal taxpayer support) and better structured to set a reasonable cap on non-standard rates can ensure that no one will be "uninsurable" by facing premiums for coverage that are either unaffordable or unavailable due to their health status.

In addition, Medicaid will continue to have a vital role to play, provided that it is substantially reformed and rededicated to its core mission of providing coverage to the lowest-income Americans. The goal of more generous support of health care access for low-income and other vulnerable Americans in the non-elderly population still must recognize federal and state budget constraints, set realistic priorities and hit sustainable targets.

Source: Tom Miller, "The End of Obamacare: Just the Beginning of Better Health Care," Economic Policies for the 21st Century, December 12, 2013.

 

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