Overlooked during the public mourning of the passing of Justice Ruth Bader Ginsburg was President Donald Trump’s announcement of his “America First Healthcare Plan,” which is an executive order essentially affirming that “Americans with preexisting conditions can obtain the insurance of their choice.”
The executive order also endorses the current legal action to strike down the Affordable Care Act, but does so without specifying how exactly those with preexisting conditions will acquire health insurance after the ACA is struck down by the courts. In summary, Trump has nothing to offer on health system reform beyond blustering, self-contradictory rhetoric.
And yet Americans clearly need real health system reform. Tens of millions of Americans were uninsured and/or underinsured before the pandemic hit, which, through job loss, caused millions more to lose what health coverage they’d had. Health care costs are killing government and family budgets while windfall profits are enriching the medical-industrial complex. Health care costs remain at the top of the list of concerns for American voters, according to numerous polls.
How can a nation so divided actually do something about these long-standing, profound health system flaws?
HR5010, titled The State-Based Universal Health Care Act, might be the answer. The ACA anticipated that states would play a necessary role in improving “Obamacare.” Section 1332 of the ACA allowed state innovation in health policy after 2017. However, states have encountered many federal barriers to real health system improvement.
For instance, the Employee Retirement Income Security Act of 1974 (ERISA) prevents states from regulating employer-funded health plans, thus negating any real health insurance reform at the state level. HR5010 proposes to allow states to negotiate with the federal government for removal of any barrier to improving health system function, including statutes (like ERISA), rules or budget regulations.
States that can demonstrate a good faith effort to provide health financing for virtually all of their residents while maintaining all federally guaranteed health benefits will be granted approval for their proposed health system reforms. What these reforms must be is not specified in HR5010; states are allowed to try out a variety of health system mechanisms, from markets to single-payer.
Many people will be wary of a state-based approach to health system reform. State governments have been responsible for many sorry outcomes in the history of our country, from the Civil War to Jim Crow laws. HR5010, however, does not cede all authority for health system function to states. Federal laws and programs — including the ACA, Medicare, Medicaid, the Children’s Health Insurance Program and many others — are the basis and minimum floor for the health system now and into the future.
The State-Based Universal Health Care Act (HR5010) merely allows any willing state to take that minimum standard of care to a higher level. Any state that succeeds through HR5010 will have greater autonomy in health policy and will serve as an example for sister states, as anticipated by U.S. Supreme Court Justice Louis Brandeis when he said “a single courageous State may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.”
Let’s all get past the useless gestures of partisanship during the decade since Obamacare was passed. Trump’s ill-begotten America First Healthcare Plan demonstrates finally that there never was a federal replacement for the ACA if it had been repealed. Obamacare is apparently the limit of what the federal government can accomplish in health system reform. Let’s give the states a chance to try and improve health care delivery.
Joseph Q. Jarvis, M.D., Salt Lake City, is a public health physician and author of “The Purple World: Healing the Harm in American Health Care.”