Critics of the Accountable Care Act continue to call for the repeal of the legislation. The Republican majority in the U.S. House of Representatives has voted 37 times to overturn the ACA. Each measure has died in the Senate. While launching repeated attacks against ACA in Congress and in the media, critics have not united behind any alternative measure. Here are six choices:
• Maintain the status quo. Our current system of health care is unaffordable, consuming 18 percent of gross domestic product while leaving tens of millions of Americans without health insurance. Even for insured Americans, high deductibles and co-payments create financial burdens. Health care costs figure prominently in half of all personal bankruptcies. New therapies, especially for malignant diseases, are unaffordable for many people. Costs for childbirth leave many couples with substantial debt. In many instances, health care is inefficient with poor communication among multiple care-givers and no coordination of testing and therapy.
• Expand Medicare. Despite being linked from the outset to common and customary pricing for services, Medicare has set a predictable pattern for care for our nation’s older citizens for almost 50 years. Administrative costs are lower than most health insurance plans. Uniform benefits and access to care are assured nationwide. Medicare’s current challenge is to maintain solvency in the face of rapidly growing numbers of elderly persons. Expansion of Medicare to a younger population would secure its financial future.
• Single payer. Each state or the federal government would assume the responsibility for building new, public funding mechanisms to pay for medical care. Government agencies would replace private insurance plans. Vermont is currently considering a single-payer option in designing its health plan. Unified Green Mountain Care (http://hcr.vermont.gov/timeline/gmc) outlines the steps to assure universal coverage for that state’s citizens. The website is a model for clarity.
• Expand Medicaid. An initial goal of the ACA was expansion of Medicaid eligibility to 138 percent of the federal poverty level. This provision was struck down by the U.S. Supreme Court in 2012. Medicaid programs vary widely in terms of eligibility and coverage. If more uniform standards were adopted and the most successful state plans were copied, Medicaid could still provide a solution for health care for impoverished people. Expansion would only work if all states were required to participate at the same level of benefits. Congressional action for this option is unlikely given current gridlock. Some state legislatures would balk at any expansion of governmental powers.