October 7, 2016


How Democrats should fix ObamaCare (Ryan Cooper, October 7, 2016, The Week)

Democrats should aim for programs that can run indefinitely on autopilot -- because chances are good that they'll only get a brief window every decade or two to fix any problems.

Medicare and Medicaid fit that bill. They aren't perfect, and do need adjustment from time to time, but they are far more stable than the jerry-rigged ObamaCare exchanges. Democratic reformers should work to put a public option on the exchanges that is as close to those single-payer programs as possible -- perhaps using Medicare rates or a formal buy-in to Medicare itself. Democratic lawmakers won't be able to do this anytime soon -- they'll need the House, the Senate, and the White House to make it happen -- but they must be ready to pounce when given the chance.

Remember, the Affordable Care Act's Medicaid expansion has been by far the greatest success of ObamaCare. Something like 16 million more people are on Medicaid and the Children's Health Insurance Program than were projected to be before ObamaCare was passed. The Department of Health and Human Services estimates that about 20 million people have gotten coverage directly due to the reform law, and about 11 million of them through the exchanges. The additional unexpected people on Medicaid are probably explained by the enrollment push rolling up people who were eligible for old-style Medicaid, but didn't realize it.

Still, it could have been far better. Because the Supreme Court made the Medicaid expansion optional, 19 conservative states are still refusing to take the money, leaving 2.9 million people directly without coverage. (Ninety percent of such people are in the South, and 55 percent are nonwhite.)

There is no reason for this to happen. Even though states are only required to pay 10 percent of the expansion cost starting in 2020, the feds might as well have carried the entire thing. Indeed, there's no reason at all for Medicaid to be the goofy state-federal partnership in the first place. Future reform ought to federalize Medicaid altogether, removing individual state governments from the decision about whom to insure. Hey presto, another 3 million more people have coverage.

If the GOP chooses not to negotiate a more free market (Third Way) system that provides universal coverage then we'll get a more Second Way one (National Health).  
Posted by at October 7, 2016 8:37 AM