In the first presidential debate on Tuesday, healthcare is sure to be one of the chief topics of conversation, especially now that a newly constituted Supreme Court could strike down Obamacare, effective perhaps as early as next year.
At the debate, Joe Biden will almost certainly go after President Trump for trying to invalidate the law — and ostensibly deprive millions of people of their health coverage. The president should welcome that attack. Obamacare is not worth saving. There are much better ideas for expanding access to affordable coverage.
The “Affordable Care Act” has not lived up to its name. Individual insurance premiums more than doubled between 2013, the year before the law took effect, and 2017.
Virtually the only people purchasing exchange coverage are those who receive generous subsidies from the federal government to help cover its cost. Uncle Sam pays at least part of the premium for 86% of the nearly 10.7 million exchange enrollees.
Health reimbursement arrangements are a better way to coax people into the individual insurance market and simultaneously give them control over their healthcare. Employers fund these accounts with untaxed dollars, which workers then use to cover the cost of a policy of their choosing. If they leave their jobs, they keep their coverage, as long as they continue paying the premiums.
The Trump administration issued a rule expanding access to health reimbursement arrangements last year. Eventually, some 800,000 employers covering more than 11 million employees and their families could take advantage of the arrangements. That influx of new customers would increase competition in the individual insurance market, which would drive down premiums and thereby reduce the number of uninsured.
It’s this type of patient-centered reform that the president should highlight when discussing his vision for healthcare in the debate.
Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes.