Pro/con: Should states accept ACA option of health exchanges?Yes: It’s a step toward single-payer coverage
By: Mark Weisbrot, Tribune Media Services
The Affordable Care Act of 2010 — widely known as Obamacare — requires states to set up exchanges where individuals and small businesses can purchase insurance.
The purpose of the exchanges is to help implement the reforms. For example, most of the people who will purchase insurance in the exchanges will be eligible for some sort of tax credit or subsidy to make their insurance more affordable. Also, the insurance plans must be certified so that they meet the requirements of the ACA.
The ACA also provides for an expansion of Medicaid to households earning up to 133 percent of the federal poverty line. The exchanges can help determine who is eligible for Medicaid or CHIP (the Children’s Health Insurance Program), or for subsidies to purchase insurance.
The ACA gives state governments the responsibility to set up exchanges. But a number of state governments have declined to do so, thus leaving this responsibility to the federal government.
Some of these state governments also are rejecting the Medicaid expansion, and federal money that goes with it. This will simply deny many of their citizens access to Medicaid — including 1.4 million people in Texas.
Obamacare will bring some important changes for victims of our broken health-care system, some of which are already in effect.
But that still leaves tens of millions of Americans falling through the cracks. We also have the most expensive health-care system in the world — paying about twice as much per person as in other high income countries, with much worse health outcomes in areas like life expectancy and infant mortality.
Most of the waste comes from higher administrative costs — one study estimated these at 31 percent for the United States, as compared with 16.7 percent for Canada’s universal, single-payer system.
The most effective, efficient and equitable system is a single-insurer that covers everyone — as we have in Medicare for Americans over 65.
For this reason the state of Vermont is designing an insurance exchange system under the ACA that will serve as a prelude to a single-payer, universal statewide health-care system; it is estimated that this will reduce health care spending in Vermont by 25 percent while insuring all residents.
The people of Vermont deserve congratulations and support for their years of grassroots activity that could make this a reality as early as 2017. The only reason we don’t have this nationwide is because of the corrupting power and influence of the pharmaceutical and insurance corporations.
If Vermont succeeds, other states and then the federal government could follow, as happened in Canada.
Mark Weisbrot is co-director of the Center for Economic and Policy Research.