Three Healthcare Resolutions for Democrats in 2018
After Republicans failed to repeal the Affordable Care Act in 2017, some Democrats might be thinking that the issue is resolved—but that would be a mistake.
Republicans successfully repealed the law’s individual mandate through their tax bill, which leaves the fate of the U.S. healthcare system as uncertain as ever. Further, Republicans have said they are not giving up on repealing Obamacare in total, and the law still faces challenges related to affordability and access for many consumers.
So as Democrats look ahead to 2018, the party should remain focused on improving the healthcare system, while staying vigilant when it comes to repeal. Here are three healthcare resolutions for the party.
Prepare to defend the ACA—again
With the individual mandate repealed, insurers will likely leave the market in 2019 if there is no additional legislation to replace it. With that hanging over Congress, Republicans will almost certainly try again to repeal and replace the ACA.
One way Democrats can prepare for new repeal proposals is to improve the party’s messaging on healthcare. Arguably, the last year has shown that Democrats do have an upper hand when it comes to this issue. The ACA has made it hard for Republicans to convince voters that returning to a more deregulated insurance market will benefit them.
Voters are skeptical when it comes to Republican proposals that would allow insurers to deny coverage or sell skinny plans, but Democrats shouldn’t take that for granted.
As costs continue to rise, Republicans will continue to pin those costs on Obamacare. Democrats should prepare for this, and advocate in favor of replacing the individual mandate with a different policy to stabilize the market. Republicans proposed their own replacement policies this year, and Democrats could choose one of those in the spirit of compromise.
Replacing the individual mandate with a more conservative policy could keep insurers in the market and give Congress time to work on a bipartisan solution for costs. But 2018 is an election year, and if Democrats don’t get out in front of the issue, Republicans will likely campaign on replacing the ACA.
Pick your platform
Another way to prepare for continued attacks of the ACA would be to stop playing defense. Many Democrats would like the party to advocate for its own proposals to improve healthcare access and lower costs. But to do this, the party needs to pick its official platform.
Right now, there are two options for Democrats—improve the ACA, or embrace single-payer. Leading Democrats have put forth plans for each. Sen. Bernie Sanders’ Medicare-for-All bill would create a single-payer system, while Sen. Tim Kaine’s Medicare X would create a ‘public option’ allowing consumers to buy into Medicare.
There are pros and cons of each proposal. Sanders’ plan would create a more universal healthcare system funded by taxes. Some consumers could pay less than they do currently for more coverage, but it would represent a huge shift from our current system, and faces a lot of challenges legislatively. Many consumers do not want the government to be fully responsible for the healthcare system.
Kaine’s plan, on the other hand, would provide consumers with another option for insurance. Medicare X would allow the government to sell an insurance plan alongside existing private insurance options. Some consumers might pay less than they do now, but there would still be costs associated with this plan, so it wouldn’t be as successful at achieving fully universal healthcare.
Democrats need to do some soul-searching to determine the right approach and where to allocate party resources in 2018.
Pass a specific improvement
Regardless of the longer-term goal the party selects, in the short term, Democrats should focus on passing a specific improvement to the ACA in early 2018.
With the individual mandate repealed, Democrats should focus first on replacing it with another policy to keep insurers from fleeing the market. Beyond that, Democrats could also work on policy solutions for rising costs.
A bipartisan proposal to fund cost-sharing reductions to insurers for two years seemed promising, but has since stalled in committee. Democrats should lead the charge on compromise, and work to get improvements passed in 2018.
If Democrats want to protect the ACA or expand coverage in the U.S., the party needs to play both defense and offense in 2018. Republicans will continue to try to repeal the ACA and Democrats should be prepared to take the reins on improving Obamacare and communicating the benefits of leaving the law intact.