cost caps is the right solution on healthcareSince Congress passed the Affordable Care Act a decade ago, we’ve gotten totally stuck on health care. The parties are at war with each other. Republicans have tried to repeal the ACA 70 times. Democrats can’t decide whether to reform the system with a “public option” or to try to replace the system outright with Medicare for All.
Meanwhile, about 4 in 10 Americans struggle to pay their medical bills.
Ladan Ahmadi, the Deputy Director of Economic Communications and Health Policy at DC think tank Third Way, says that we don’t need giant reforms to the system. We need to focus on what people actually say the need. There is something that we could do right now that is practical, that everybody understands, and that would actually make a big difference in people’s lives.
In fact, we’ve already started doing it.
Listen to the full conversation here:
This conversation has been condensed and edited.
Matt Robison: What happened on healthcare policy during the Trump administration?
Ladan Ahmadi: President Trump was very vocal about wanting to repeal the ACA. [When he failed to do that] his administration purposely tried to destabilize it . So they cut the advertising budget for the Healthcare.gov website by 90%. They also cut programs that help people sign up for insurance by nearly 40%. And lo and behold, for four years enrollment in the ACA was flat. Now [under President Biden and efforts to encourage enrollment] approximately 31 million people are covered. That’s the highest it’s ever been.
Matt Robison: But even with the good that the ACA has done, people are still experiencing painful costs. That’s tough when 80% of Americans live paycheck to paycheck.
Ladan Ahmadi: That’s right. Medical debt is an enormous problem. It affects everyone. Two-thirds of [Black and Latino Americans] say that a medical expense of more than $500 could bankrupt them.
Matt Robison: Under the American Rescue Plan this year, wasn’t there some progress on containing how much people have to pay?
Ladan Ahmadi: Yes. Congress passed an 8.5% cap on people’s healthcare costs. This only applies to people who get insurance through the ACA marketplace exchanges. But it’s a big deal. This change has already lowered healthcare premiums for 24 million Americans by an average of 25%. A family of four making $90,000 would see their premiums decrease by $200 a month.
Matt Robison: So what you are proposing is, to make progress on healthcare, we should focus on “supersizing” those cost caps?
Ladan Ahmadi: Yes. Let’s make it a universal benefit, something that affects everyone no matter where they get insurance. This should include people who get insurance through their employers, or people who get their insurance through Medicare, or Medicaid. Everyone needs a cost cap. People should know that no matter what happens, even if a catastrophic event happens, they will not be forced to pay more than 8.5% of their income toward healthcare.
Everyone would know what that means, and they would know how they would benefit from it. That kind of security is what’s missing from the healthcare system.
Matt Robison: What I like about this is that policymakers get stuck on big proposals that no one understands, or wonky details that no one cares about. For example, what’s the difference between a premium and a deductible and a lifetime deductible cap and a preexisting condition?
Ladan Ahmadi: Exactly. What really matters to people is the bottom line. That is the reason why people are so sick of this healthcare debate. They are saying, I don’t really care what you guys decide on, as long as I’m not going bankrupt paying for medicine when my child gets sick.
Matt Robison: So is that why you say we should be focusing on this issue, not all the other big, sweeping reforms that people talk about?
Ladan Ahmadi: I think focusing on limiting costs is the answer to our stalemate right now, because it doesn’t disrupt the system. This is something that Democrats could implement now with their current majorities in Congress. It is what President Biden ran on. This is what he promised the American people. Poll after poll is showing that healthcare costs are either people’s number one or number two concern.
This approach is simple. You know exactly what it means. You know what it would mean for your own family and also for someone else, so it doesn’t feel like other people are getting all of the benefit. Remember, 92% of the electorate already has insurance. So universal coverage is a great goal, and I support it, but most of the benefit goes to a smaller slice of the American people. This benefits everybody, it’s fair, and everyone gets it.
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Matt Robison is a writer and political analyst who focuses on trends in demographics, psychology, policy, and economics that are shaping American politics. He spent a decade working on Capitol Hill as a Legislative Director and Chief of Staff to three Members of Congress, and also worked as a senior advisor, campaign manager, or consultant on several Congressional races, with a focus in New Hampshire. In 2012, he ran a come-from-behind race that national political analysts called the biggest surprise win of the election. He went on to work as Policy Director in the New Hampshire state senate, successfully helping to coordinate the legislative effort to pass Medicaid expansion. He has also done extensive private sector work on energy regulatory policy. Matt holds a Bachelor’s degree in economics from Swarthmore College and a Master’s degree in public policy from the Harvard Kennedy School of Government. He lives with his wife and three children in Amherst, Massachusetts.