As tempting as starting over from scratch can seem with a new Congress, when it comes to health care, we already have a plan. It’s called the Affordable Care Act (ACA), and it is working.
Nearly 20 million more Americans got covered. Health care cost inflation slowed. And people have more choices. The ACA has also given small businesses more bargaining power, increased worker productivity and mobility, and invested in preventative care that will reduce the long-term cost of chronic conditions like diabetes and heart disease.
It’s not perfect, but it is progress, and many business leaders would prefer to fix our current system rather than start all over again from scratch.
Health care is a complicated business, but the market forces capable of controlling health care costs are simple: information, competition, and incentives. Both repeal and Medicare for All transfer authority without directly managing those market forces. Business leaders understand this, and need our policymakers to as well. This fall, I surveyed our network of business leaders across the country on a range of health care issues. Looking past the rhetoric on both sides, business leaders want real solutions on health care that are rooted in proven plans.
On repeal, business leaders worried most about what would happen to people, including their employees, if they lost access to health insurance. Nearly 80 percent are concerned that repeal would cause millions of people to lose coverage, and 73 percent are specifically concerned about losing coverage because of pre-existing conditions like asthma, pregnancy or diabetes. 72 percent are concerned repeal will cause insurance premiums to rise.
On Medicare for All, business leaders worry most about giving Congress and the Department of Health and Human Services (HHS) control over 950,000 doctors, three million nurses, 5,500 hospitals, and the 51 million medical procedures they perform each year. More than 60 percent of the leaders we surveyed were concerned that Medicare for All would allow the current Administration to choose what and who gets covered.
At a time when the Trump Administration is shutting off navigation assistance for ACA exchanges and shortening enrollment periods, we have to question what it might do if left in control of the entire health care system. We must also ask how well a system can perform if its operating principles change with each new Congress or Administration.
One business leader who had lived abroad noted she had “seen the delays and other issues caused by a universal healthcare system and experienced the excessive taxes required to support it.”
On our current system, business leaders would most like to see continued expansion of coverage and strategies for lowering costs. They are not alone in this. Proposals to improve, protect, and extend the ACA have been offered by a bipartisan group of governors, the Bipartisan Policy Center, and the House Problem Solvers Caucus.
Before we throw out the ACA, let’s remember how little we know about its opponents’ plans to replace it. Republicans in Congress have voted to repeal the ACA 50 times, but they have yet to offer a comprehensive alternative. Some Democrats in Congress support one or more Medicare for All proposals, but no one has offered a real budget or comprehensive guidance on how coverage decisions would be made.
The ACA works because it uses information, competition, and incentives to drive down costs and expand coverage. We can build from the ACA to expand coverage and reduce costs. Let’s stick to the plan.
Jim Doyle is President of Business Forward, a bipartisan network of more than 100,000 civic-minded entrepreneurs, investors, small business owners, and executives working to end gridlock in Washington.