Vox had an article about The Urban Institute’s plan to expand health insurance coverage: the Healthy America program.  The plan incorporates the existing system, especially the employer-based coverage that covers half of Americans, and offers a public option similar to Medicare and Medicaid to more people.

The article gives a great summary of the plan:

• A new insurance market would feature private health plans and a public option.
• Much of the Medicaid population would move into this new market: Children and the disabled would receive supplemental benefits to make sure they get the same level of coverage as they currently do, and the program would continue to cover long-term care separately.
• The default plan would be more generous than the ACA’s: covering 80 percent of health care costs, compared to 70 percent. Lower-income people could also choose plans that cover an even higher share of their health care costs.
• Premiums would be based on a sliding scale and more generous than Obamacare’s. People who make 138 percent of the federal poverty level or less ($27,000 for a family of three) would pay no premiums for that default plan, and premiums would rise slightly the more income a person makes. There would be no upper limit for subsidies as there is under the ACA: A family making more than 400 percent of the federal poverty level ($98,400), which is the current cut-off for assistance, would not have to pay more than 8.5 percent of their income on premiums for the default plan.
• Rather than have an individual mandate, Americans would lose a share of their standard tax deduction if they were uninsured. The goal is to find a balance between the need to encourage healthier people to buy insurance while recognizing the unpopularity of the mandate, the Urban Institute researchers said.
• Low-income people — those eligible for food stamps or cash welfare programs — would be automatically enrolled in an insurance plan if they are found to be uninsured.
• Payments to health care providers under these Healthy America plans would be capped at Medicare rates.
• Obamacare’s rules prohibiting preexisting conditions and requiring that certain essential health benefits be covered would remain.
• Employer-based insurance, the traditional Medicare program, the Veterans Administration health care program, and the Indian Health Service would be left in place.

At the top level, there are several important features to this plan

1. It would not disrupt the existing employer or Medicare populations. I think that is the first challenge for a universal single-payer plan, so the Urban plan seeks to avoid it — though the tradeoff is it will not achieve universal coverage.
2. By combining the Medicaid population with the individual market, the Healthy America program would have a bigger customer base (and risk pool) than Obamacare currently does, which could help prevent some of the adverse selection that has driven up costs in the ACA. The caps on provider payments would also help keep costs down.
3. Much of the program’s costs (another challenge for a truly universal health care system) would come from existing sources — Medicaid and the ACA in particular. But there would be a need for new funding: Urban suggests increasing an existing Medicare tax to raise about $800 billion over 10 years, which they think would cover much of the new costs.

The Urban Institute projected that if we swapped out Obamacare for Healthy America, the uninsured rate would drop from 10.9 percent to 6.7 percent in 2019. That would still leave 18.4 million Americans uninsured — a big flaw, I’m sure, in the eyes of people advocating for a truly universal health care program — but that is down from 34.3 million uninsured currently.

Slate had an interesting article arguing that ObamaCare was working until Trump’s sabotage of the health care plan.  New data shows that, in 2017, the market finally stabilized. For every dollar they collected in premiums last year, insurers paid out 82 cents on medical claims on average, according to a recent report by the Kaiser Family Foundation. That’s down from 96 cents in 2016 and $1.03 in 2015. “After several years, the remaining insurers figured out how to earn a profit in the individual insurance market,” Kaiser Senior Vice President Larry Levitt said.

Insurers adjusted their premiums high enough that insurers could finally make a profit, and would set the market up for much gentler, single-digit price increases in the future.  However, thanks to Donald Trump’s decision to stop paying key subsidies to insurers, premiums shot up once again this year. Early evidence suggests they’ll rise by double digits once again in 2019 in order for insurers to avoid losing money, largely because Republicans chose to repeal Obamacare’s individual mandate, which kept insurance prices down to some degree by requiring all adults to obtain coverage. Middle class families that don’t get financial help are going to take a hit, and many could be priced out of the market.

Again, this could have easily been avoided, had Republicans just left the law alone, instead of trying with every ounce of their power to wreck it. For a hot second, Obamacare was working roughly as intended. And now it’s broken again, and the uninsured rate and cost of health care is on the rise.

The Centers for Medicare & Medicaid Services recently rejected a proposal from Kansas to place a three-year lifetime cap on some adult Medicaid enrollees. Arizona, Utah, Maine and Wisconsin have also requested lifetime limits on Medicaid.  Since Medicaid began in 1965, no state has restricted how long beneficiaries could remain in the entitlement program.

All these states expanded Medicaid under the Affordable Care Act to cover everyone with incomes of more than 138% of the federal poverty level ($16,753 for an individual). The work requirements would apply only to adults added through that ACA expansion.