When voters understand how Obamacare works, they are more likely to support its improvement than its repeal. I've found this to hold true across political parties.
As more time passes, the ability to repeal Obamacare shrinks. In my opinion, we've crossed the point at which full repeal is possible. Going forward, I expect there to be more discussion on how to improve upon Obamacare.
Here are a few ideas for how we can make Obamacare better.
1) Require insurance companies to offer all ACA-qualified policies through the State Marketplaces.
Right now some insurance companies offer policies on the State Marketplace and some offer policies off of it. This creates confusion for consumers and makes it hard to compare all available policies in one place. It also leads to families missing out on premium tax credits, which are not available on policies purchased outside of the Marketplace.
2) Permanently expand the premium tax credits to apply to everyone, regardless of income.
Prior to 2021, Obamacare prevented households earning more than 400 percent of the federal poverty level (FPL) from qualifying for premium tax credits. This "subsidy cliff" created a disincentive for people to earn more money when they are on the edge of qualification. The American Rescue Plan (ARP) temporarily fixed this for 2021 and 2022. We should make this fix permanent.
3) Remove the employer mandate or fix the family glitch.
The current employer mandate incentivizes employers to "screw" their employees out of premium tax credits that would make health insurance more affordable for them. In 2021, your employer coverage is considered affordable as long as you’re not required to pay more than 9.83 percent of your income to cover yourself. This calculation is unfair to households of two or more because it does not consider affordability for the entire family. Policy advocates refer to this issue as the family glitch. To avoid a tax penalty, employers offer skimpy plans that disqualify employees from premium tax credits. We should either nix the employer mandate or fix the family glitch.
4) Make it easy for employers to contribute to their employees' out-of-pocket health insurance costs.
The current regulations make health reimbursement arrangements (HRAs) unattractive because they offset the premium tax credits. Employers should be able to help employees with the portion of the premium that isn't subsidized without screwing lower-income employees out of tax credits.
5) Make it so all health insurance plans are HSA-compatible.
This would reduce confusion around health savings accounts and allow all Americans to take advantage of them, regardless of plan choice.
6) Create incentives for people to buy marketplace health insurance over non-ACA-qualified alternatives.
We need more healthy people to participate in the Marketplace risk pools instead of going uninsured or buying short-term medical and health sharing plans. One way to do this would be to expand the premium tax credits. Another would be to bring back the individual mandate. I prefer the carrot to the stick.
7) Remove agent commission from the medical loss ratios (MLRs).
This would stop penalizing insurance companies for paying agents to assist consumers. Right now, paying a third-party agent comes out of the insurance companies' capped profits. It shouldn't.
8) Do something to simplify provider networks.
I haven't thought about this enough to offer specifics here. Provider networks and non-transparent pricing are a problem. I think pricing transparency would go a long way here.
9) Create tax parity for employer-provided and consumer-purchased health insurance.
Either eliminate the tax exclusion for employer-paid health insurance or make it so individual families who buy their own coverage can deduct their health insurance costs. This is only fair and will accelerate the end of employer-provided health insurance.
10) Increase standards for licensed health insurance agents.
There is too much selling and not enough service provided by traditional health insurance brokers. Insurance agencies like LegUp Health and their agents should be held to higher standards.
11) Require all politicians and government employees to buy their own health insurance through their State Marketplace.
Pay them more salary to cover the cost.
What other ideas would you add to this list?