Joseph Q. Jarvis: The Affordable Care Act isn’t: So, what is?

(AP Photo | Jon Elswick) The HealthCare.gov website is photographed in Washington on Dec. 15, 2017.

Middle-class families across the United States who have no employment-based health benefits are increasingly finding the cost of health insurance offered under the aegis of the so-called Affordable Care Act to be, well, unaffordable.

Tens of millions of taxpayers paid the penalty for failing to have health insurance during the years since the implementation of the ACA, mostly coming from the lower middle class. About four in 10 uninsured Americans do not buy health insurance because they cannot afford it. The federal government spends $700 billion per year subsidizing or outright paying for health care for citizens under 65 years of age, but nonetheless, 30 million Americans have no organized financing for needed care. These Americans are increasingly turning to online begging for health funding.

Most of the “coverage” actually realized by the Affordable Care Act came through growth in Medicaid enrollment. Private health insurance is actually far more expensive to subsidize than Medicaid. But again, the middle class is left out. Medicaid enrollment requires an income at or just above the federal poverty level. What incentive do poor people have to work hard and emerge from poverty if they know that by so doing they will lose their health care financing and not be able to afford to replace it? Those families with chronic health problems, such as children with asthma and diabetes, certainly know that they place their children at mortal risk by earning more than Medicaid rules allow.

Increased Medicaid enrollment has come at a price for the taxpayer. Growth in combined federal and state Medicaid budgets is projected to exceed GDP growth throughout the coming decade. At the federal level, rising health care costs, including Medicare, Medicaid and many other federal programs, are the sole drivers of the growing federal deficit. State budgets, which currently inject $700 billion each year in the U.S. health system, likewise, while usually balanced, must experience opportunity costs as funds are increasingly shifted to Medicaid, instead of education or other public programs. Health care “business-as-usual” in the United States is not sustainable.

The Affordable Care Act is not affordable. It also didn’t protect any patients. But then, it never was about cost or quality. The legislation was principally aimed at providing coverage for uninsured Americans. And there it failed as well. Even with optimal implementation, tens of millions of Americans, mostly middle-class, were left behind without health financing.

Given the failure of the Affordable Care Act, why is it that our national political debates about health care still revolve around “Obamacare”? Why can’t we all agree that we’ve wasted nearly a decade on legislation that hasn’t succeeded and look for something better?

I suggest that congressional hearings about improved Medicare for all would be a start, although it would have the major drawback that such hearings would command the approval of only a portion of the electorate. Many Americans are suspicious about federal solutions for every problem. These Americans might have interest in alternative single-payer possibilities at the state level. Many economic analyses projecting health care costs after implementation of a single-payer health system have found that universal coverage of entire state populations can be accomplished for less cost if the administrative waste of the health insurance business model is eliminated.

Why not include state-based single-payer reform in the coming congressional hearings about Medicare for all? Is it possible that bipartisan support for state-based single-payer health system reform might replace the silly partisan bickering about the Affordable Care Act?

Joseph Jarvis

Joseph Q. Jarvis, M.D., MSPH, Salt Lake City, is a public health physician and author of the book “The Purple World: Healing the Harm in American Health Care”.