When he first ran for president, Barack Obama promised universal access to health care insurance – without forcing people to buy it. His campaign position sought to balance personal choice in health with a guarantee of care. Now the next president, Donald Trump, promises a similar path. “We’re going to have insurance for everybody,’’ Mr. Trump said last week, while praising popular aspects of the 2010 Affordable Care Act (aka Obamacare).
His statement is a signal that perhaps Congress might yet find a bipartisan way to fix a law that both Democrats and Republicans agree needs some degree of change.
The GOP hopes to pass a health-care bill by spring – although it will need Democratic votes in the Senate to do so. The two parties still differ on many details about a fix, such as whether states should be allowed to customize health care to local needs. But the political momentum exists to offer more freedom in health care and to offer more affordability in how people find healing.
For millions of Americans without employer-based care or for those not eligible for Medicare and Medicaid, the various GOP ideas rely on the use of tax credits and special savings accounts to purchase insurance. This market-based approach is similar to the 2003 Medicare Modernization Act. Congress passed that law with bipartisan approval – and it has indeed expanded access to care while helping to restrain rising costs.
The proposed reforms in the new Congress would end one of Obamacare’s most controversial aspects: the onerous mandate for individuals to buy a private insurance policy or face a stiff penalty. Millions of Americans have tried to avoid that rule, sending a strong signal for choice in health care. One alternative to the mandate is to offer positive incentives for people to maintain insurance coverage, even during periods when they are healthy.
Whatever Congress does in fixing the current law, it must keep an eye on how the Supreme Court might rule on any new law. In two key decisions that upheld aspects of Obamacare, Chief Justice John Roberts made a point of bowing to the intent of the legislative branch while also upholding basic liberties. The Constitution’s liberty provisions only allow government to “encourage” individuals to buy a private product, such as health insurance, not coerce them into doing so. And both states and the insurance markets deserve certain freedoms in providing care.
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” the chief justice wrote. “If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”
Republicans and Democrats agree on the principle of access to affordable care for all. They also agree that health is a basic and natural good for each individual. If both parties can stop seeking partisan advantage for the next election, they can make sure that good is more available as well as more affordable.