In the midst of a devastating pandemic, fresh ideas to cover the 30 million currently uninsured Americans are more important than ever. Jim Capretta, health care expert at the American Enterprise Institute, says we can do a lot right now with some common-sense steps: “there’s literally tens of millions of people out there who are considered uninsured, but really should be insured because we’ve already created something for them.”
Listen to the full conversation here:
The following is an excerpt from our conversation on the Great Ideas podcast about these innovative ideas.
Matt Robison: Over the course of the last decade, the US has remade the way we pay for people’s healthcare coverage through the Affordable Care Act, also known as Obamacare. Everyone agrees that we still need to expand coverage and control costs. They just can’t agree on how to get there. So Jim, what changes did the ACA make to healthcare coverage and delivery in America?
Jim Capretta: Two things. One was to vastly increase the subsidies that would help people who struggled to afford insurance. That had two parts: expanding Medicaid – which is our safety net health insurance program in the United States – and creating premium subsidies when people buy their own individual insurance. The second thing was to say that anyone who was sick previously with a so-called preexisting condition would be treated just like anybody else. That was a big deal.
Matt Robison: What did the ACA get right? And what gaps did it leave?
Jim Capretta: What they did well was to create a new subsidy system for buying on the individual market that didn’t actually create a whole new bureaucracy. It’s kind of amazing. You basically go on these ACA-sponsored exchange websites, and if you’re a person eligible for a subsidy, you automatically get signed up for it. We used to have 15% uninsured in the United States and it’s down to roughly 7%.
In terms of gaps, obviously if you’ve cut something in half there’s half left to go. The other big thing that hasn’t been solved in the United States is that there isn’t cost discipline.
Matt Robison: Are the bigger reforms that both parties have proposed likely to happen?
Jim Capretta: There’s a rule in politics when it comes to healthcare: there’s lots of big talk, but generally, and this includes the ACA, the changes that are made are incremental. They have to build upon what exists because disruption is so politically unpopular. That was true with the Republicans when they tried and talk about repeal and replace. And it’s the same thing with Medicare for All – that’s just a very, very tough sell.
Matt Robison: You wrote an op-ed in the New York times suggesting not just one but three ideas for compromises that can happen. What’s the first of your great ideas for healthcare?
Jim Capretta: There’s about 30 million people in the United States who don’t have full year health insurance enrollment. 20 million of those folks are already eligible for either public insurance, mainly Medicaid and the children’s health insurance program, or subsidized private insurance through the Affordable Care Act exchanges.
So what you could do is move towards something called automatic enrollment. On the federal tax form, if you were uninsured last year, and if your income is below a certain level, the States would put you into either Medicaid or one of the subsidized options through the Affordable Care Act exchanges. And this would be automatic. You could opt out if you didn’t like it. But otherwise you are in, and a lot of times you would owe no premium for it.
So this is a way of trying to say, look, there’s literally tens of millions of people out there who are considered uninsured, but really should be insured because we’ve already created something for them. Let’s figure out how to get them into it.
Matt Robison: So with a very simple change…we could add millions of people?
Jim Capretta: That’s right. This is a way of the government trying to get on the side of people and say, let’s make it easy for you.
PoliticusUSA readers – and my podcast listeners – say they want more thoughtful, positive analysis covering not just our problems, but also some solutions. This excerpt is from my new podcast that does exactly that, called “Great Ideas.” Each week, the host interviews a different policy expert from across the political spectrum who offers constructive ideas for how to fix our challenges.
In collaboration with PoliticusUSA, we’ll be offering excerpts in this space every week. I hope you’ll keep coming back to read more, and also subscribe to the podcast. To hear Jim Capretta’s other innovative ideas for health care, my discussion with PoliticusUSA Editor-in-Chief Sarah Jones, and to subscribe, check out the full episode Apple Spotify, Google, Anchor, Breaker, Pocket, RadioPublic, or Stitcher
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.