The Democratic Party that is defending the Affordable Care Act before the U.S. Supreme Court next month is the very same Democratic Party that is proposing even bigger changes to our health care system.
Though former Vice President Joe Biden prevailed in his party’s presidential primary, he was the last remaining proponent of former President Barack Obama’s signature achievement. The other candidates — including Biden’s vice presidential pick, Sen. Kamala Harris — were all calling for some form of Medicare-for-All. Even Biden now supports a “public option,” which is essentially Medicare-for-All-Who-Want-It (and would soon crowd out private insurance).
And they were right to look for another approach. The ACA is a failure, our health care system is still in need of reform, and the state of Texas is right to challenge the constitutionality of the law in court. (My organization, the Texas Public Policy Foundation, is representing the individual plaintiffs in that case.)
It’s not simply the ACA’s broken promises, though those are legion. We never saved $2,500 per family. Too many of us didn’t get to keep our doctors or our insurance policies. Our premiums have skyrocketed, and insane deductibles are keeping families away from health care providers.
The ACA also failed to achieve its aims. The goal was to get more people into their doctor’s office sooner and more often. This would help cut costs by ensuring that ailments were addressed more quickly.
But because reimbursement rates were set so low, hundreds of thousands of doctors opted out of the exchange plans, and the number of doctors who accept new Medicaid patients hasn’t risen along with the demand (the expansion of Medicaid is the backbone of the ACA). And the ACA failed to reduce the costly use of emergency rooms.
Nor did the ACA protect families. Studies show the ACA did not decrease bankruptcies related to medical bills, nor did it result in significant improvements in mortality rates (just 0.8% fewer deaths among the expanded Medicaid population, according to one study).
Defenders of the ACA say that if the law is struck down, then millions of families will be left unprotected. The truth is that millions of American families already find health care unaffordable and out of reach.
But striking down the ACA could be the impetus Congress and all 50 states need to address our system’s major problems — and put patients in charge of their own care. It will end the federal stranglehold on the industry and allow patients to get insurance that meets their needs at a price they can afford.
The states that expanded Medicaid are free to keep their expanded rolls. The states that didn’t — including Texas — can try new approaches, such as Direct Primary Care, guaranteed coverage pools for pre-existing conditions and Federally Qualified Health Centers. That’s how we can improve care — not just coverage.