Industry Voices—ACA repeal's demise is more evidence that healthcare policy has moved to the left

Kent Bottles
Kent Bottles

With the dramatic collapse of the Graham-Cassidy healthcare bill, it appears that Congress is unlikely to address healthcare in the next few months in any comprehensive way.

But now might be a good time to examine the healthcare agendas of progressives and conservatives to determine what the future might hold. 

Progressives are committed to protecting the Affordable Care Act and extending healthcare coverage to all Americans. There is not consensus about how to accomplish this goal:

  • Some are advocating for “Midlife Medicare,” which would be open to citizens ages 50 to 64, per an article from The American Prospect.
  • Sen. Brian Schatz, D-Hawaii, has proposed a bill that would extend the Medicaid program to all who wanted to seek coverage under that program.
  • Sen. Bernie Sanders, I-Vt., has garnered support from many mainstream Democratic senators for a “Medicare for all” measure.
  • Others point to the cautionary tale of Vermont’s failed single-payer plan called Green Mountain Care and think that expanding Medicaid, providing coverage for immigrants, fixing the ACA family glitch and extending CHIP are the best ways to go, as Vox explained.

Conservatives, meanwhile, are in disarray after a Republican-controlled Congress has repeatedly failed to repeal and replace the ACA. While Democrats agree on trying to provide coverage for all Americans, Republicans cannot even agree on what their healthcare policy goals should be. 

Since many conservatives do not think the federal government should play any role in healthcare, opposition to the ACA is easier than coming up with a replacement solution. Leading conservative experts do not agree on what to do next:

  • Michael Cannon of the Cato Institute still thinks repealing the ACA is the only way to go, according to Vox.
  • Avik Roy of the Foundation for Research on Equal Opportunity would favor a system similar to Switzerland's with universal coverage through private insurance and subsidization, but no individual mandate, per the article.
  • Doug Holtz-Eakin of the American Action Forum would focus on changing the delivery system to decrease cost and not concentrate on insurance coverage, Vox added.
  • Senator Ted Cruz, R-Texas, has proposed allowing insurers to sell non-ACA-compliant plans in any given state as long as they sell at least one ACA-compliant plan there.

It is difficult to predict what will happen with healthcare policy in the future. An article from FiveThirtyEight foresees four possible outcomes:

  • The GOP finally repeals and replaces the ACA next year.
  • The executive branch undermines the ACA.
  • Bipartisan congressional fixes strengthen the ACA.
  • The Trump administration implements the ACA.

However, the fact that the ACA increased the number of insured individuals by 20 million has changed the terms of the debate in favor of more federal government involvement rather than less.

The ACA changed an abstract discussion about conservative versus liberal values into a concrete reality of taking away healthcare benefits from millions of Americans. Poll after poll has established that Americans would like the government to provide a healthcare safety net, as the LA Times noted.

It is perhaps ironic that the successful Republican campaigns to take over the White House and Congress have resulted in America moving closer and closer to universal coverage. 

Kent Bottles, M.D., is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics.