Building on a Healthcare Win

When the Republicans’ first pass at healthcare went down in flames, Democrats everywhere raised a cheer.

The healthcare plan — President Trump’s first major legislative priority — would have gutted the Affordable Care Act, dumping millions of currently insured Americans from insurance roles in exchange for what was expected to be a modest reduction in the deficit. A big tax cut — for the rich, of course — was included, for good measure. And still, the Republicans failed to put the bill up for a vote.

The post mortems focused on the politics: Moderate Republicans were afraid of the electoral repercussions, given the ACA’s sudden popularity; the so-called Freedom Caucus, i.e., the most conservative Republicans, didn’t think the bill went far enough in repealing the ACA. And the Democrats, as was expected, sat on their hands and watched or rallied the grassroots

The GOP is now working on a new plan, one far more Draconian — among the provisions reported is an end to the protections for those with pre-existing conditions — but it is difficult to see a real path forward. Moderates — or what passes for moderates — in the Republican Party still need to be concerned with angering their constituents, and the Freedom Caucus doesn’t care.

Any hopes for repeal, then, would need Democratic support — and that’s not likely to happen. Politically, there’s no reason for Democrats to do anything. They’re not in power, so any changes cannot be blamed on them unless they sign off. And the ACA, which has been much maligned, is suddenly popular. More than half of poll respondents in recent Gallup and Pew Research polls now back the ACA.

But Democrats should not fool themselves. The Affordable Care Act was an improvement on what had existed before President Obama took office it increased the number of insured Americans by 22 million and expanded subsidies for a swath of Americans living just above the poverty line. It prohibited discrimination against people with pre-existing conditions and allowed children to remain on their parents’ plans until they were 26.

These are important gains, but I’m not sure we can call the ACA a success. Cost increases have slowed, but they continue, and many Americans — those above the subsidy cut-off but decidedly lower-income — have found themselves struggling even more than they had before the ACA went into effect.

Part of the problem is that the ACA leaves the insurance companies in the driver’s seat without looking at the way we provide care or whether the care options we feel entitled to actually make us healthier as a nation.

Numbers can be misleading, but Americans spend nearly twice per capita when compared to the rest of the industrialized world. Despite this, our health outcomes are inferior and dangerously dependent on income and geography. State exchanges were supposed to address some of these issues — consumers would chase the cheapest options as if these plans were any other consumer goods — but political opposition in Republican-controlled states dampened their impact.

Democrats need to acknowledge the ACA’s flaws, along with its successes, and start talking about how to make the ACA better. This is not just about politics or about drafting a new narrative or counter-narrative, but about improving healthcare in the United States. To do that, we need to move toward a single-payer plan or Medicare for all — a plan that would be both universal and would remove the for-profit insurance industry from the system.

This can’t happen overnight, and not only because of Donald Trump. Democratic opposition is likely to be high, as well, but progressives in the Democratic Party would be smart to create a road map that could get us there. The road map would need to include a revival of the public option — public health plans that would compete on state exchanges with the private plans and that, presumably, would be cheaper and more efficient — followed by an expansion of Medicare to cover Americans at earlier ages (say 50). This would run counter to the current trend of raising the age of qualification, but by bringing in younger, and likely more healthy consumers, it could address some of the fiscal issues facing the program. We could then allow people to buy into Medicare at even younger ages, which many believe will make the program a more attractive option. As more people buy in, it creates momentum for expanding the program — or so the theory goes.

Will it work? I think so, but we can’t know for sure unless we start the process. What we do know is that the ACA is limited and that going back to pre-ACA days would be a disaster. We also know that most of the Republican plans — a mix of savings accounts and free-market pipe dreams — will do little to address the main issues of access and cost.

With the GOP preoccupied with tearing things down, Democrats have an opportunity to offer something better. It’s time they did.

Hank Kalet is a journalist and poet in New Jersey. Email,; blog,; Facebook,; Twitter, @newspoet41 and @kaletjournalism.

From The Progressive Populist, May 1, 2017

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