The Journal Gazette
Sunday, July 25, 2021 1:00 am

Healthy debate: Post-ACA options emerge

Troy Cozad

Many Americans likely heaved a sigh of relief at the recent Supreme Court decision to again uphold the Affordable Care Act.

Certainly among these are the more than 31 million people who depend on some aspect of the ACA for their health care coverage, including 4 million people who have enrolled in ACA plans during this year's special enrollment period.

The ruling also benefits about 130 million Americans who need ACA protections against preexisting conditions coverage discrimination; most people needing health care who face retirement prior to age-65 Medicare eligibility; and anyone who works part time, for small employers without health insurance, or as a contract employee not eligible for employer-sponsored health coverage.

No wonder polls show a majority of Americans support the ACA.

While the court's ruling deflected this latest partisan attack on the law, a number of additional key proposals for health care reform are coming up quickly. Among these are:

Make permanent recent ACA changes. The American Rescue Plan Act passed in March substantially increased subsidies and reduced premiums and out-of-pocket maximums for ACA Marketplace plans. This eased the affordability concern that was a major complaint with these plans. Unfortunately, the provisions currently will last only through 2022; in the recently released American Families Plan the Biden Administration has proposed making them permanent.

Create a “public option” universal plan. Recent polls found most Americans now believe it's government's responsibility to ensure all Americans have health care, and 68% of voters support a government effort to achieve universal coverage through a mix of employer, government and private insurance plans – though not “Medicare for All” or a government single-payer plan.

A solution candidate Joe Biden proposed is a government-administered plan, likely through ACA exchanges, that would provide an option for basic essential health care coverage at minimal cost for anyone who needs it. Two congressional Democratic committee chairs overseeing health care policy, Rep. Frank Pallone of New Jersey and Sen. Patty Murray of Washington, are pursuing this idea and have sought input from interested parties by July 31 on how to structure such a plan.

Of note, Nevada, Colorado and Washington have already established their own state public options.

Expand Medicare eligibility. The American Families Plan includes a proposal to add vision and dental care to traditional Medicare, thus avoiding the need to use Advantage plans to obtain such coverage.

At present, and I think regrettably, no effort to lower Medicare eligibility to age 60 is included in current proposals. I believe this would be a tremendous benefit for older American workers who desire, or who are forced into, early retirement with few good options to obtain health care coverage before they reach age-65 Medicare eligibility.

Several progressive legislators have hinted this idea may still emerge.

Initiate negotiated Medicare prescription drug pricing. Something's just wrong when Americans must pay several times what our neighbors do for the same prescription. Negotiated pricing will save billions in government program drug costs and will likely reduce drug costs even beyond Medicare as other health insurance providers follow its lead.

Obviously, there are pros and cons to all these proposals. For example, any expansion of Medicare would have to address how to fund an expanded program, whose Hospital Insurance Trust Fund is projected to become insolvent as early as 2024 and whose reimbursement levels often don't even cover a provider's cost of care.

The point is these proposals are worth debating, and it is in every American's interest to stay informed.

We can do better in correcting deficiencies with our country's health care insurance coverage; now is the time to cure these ills.

Troy Cozad is a long-time Fort Wayne resident.

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