September 13, 2022 | Blog | Updates

Blog: The Path Forward in Health Care: Building on The Strengths of our Current System  

By Lauren Crawford Shaver 

Access to affordable, high-quality health coverage and care continues to be a top priority for Americans. As Congress returns from the August Recess and Americans look for what is next in health care, building on what’s working – not creating new government-controlled health insurance systems – should continue to be the priority for state and federal policy makers. 

With incredible gains in coverage over the last 12 years, strengthening and building on our health care system – where private coverage, Medicare, and Medicaid work together – has given millions more Americans access to affordable, high-quality health coverage and care. According to the most recent data available from the Kaiser Family Foundation, 158 million Americans receive coverage through their employer, 18.7 million have non-group coverage, 45.3 million receive coverage through Medicare, and 63.2 million receive coverage through Medicaid and CHIP. During the latest open enrollment period, 5.8 million Americans gained new coverage under our current system. And according to data released by the U.S. Department of Health and Human Services this month, the national uninsured rate reached a record low of eight percent in early 2022. 

Some policymakers continue to tout government-controlled health care systems, like the public option or Medicare for All, as the path forward. But why would we start over, by creating an unaffordable and unproven government-controlled program? 

Earlier this year, California joined the long list of states who have unsuccessfully proposed legislation for a government-controlled health insurance system. California lawmakers halted their attempts at passing a single-payer system when it became clear the legislation would cost the state $222 billion per year. Other states, including Vermont and Connecticut, have also abandoned similar attempts due to costs. 

Washington State’s version of the public option has had disappointing results. In many parts of the state, premiums for the public option plan are actually more expensive than comparable commercial plans and less than one percent of plans sold on the Washington exchange were public option plans. And in Colorado, the legislature failed to pass a true public option, instead advancing a poorly designed rate-setting bill. Recent actuarial analysis also warns that the Colorado Option could limit access to affordable, high-quality health coverage and care, including for those in vulnerable or underserved communities. 

At the federal level, research continues to show proposals like the public option and Medicare for All are unaffordable.  One study found a federal public option could lead to a new payroll tax costing Americans about $2,300 per year in higher taxes. According to the nonpartisan Congressional Budget Office a federal public option could cause coverage disruptions and premium increases for currently insured Americans, a reduction in coverage options, and reduced access to care for seniors and low-income families, while also harming care providers and existing health plans. Other research shows a one-size-fits-all single-payer system, like Medicare for All, could come with unprecedented costs, including a $24,000 a year tax increase on the average family, tripling payroll taxes and doubling other taxes , increased federal spending by 60 percent, and an inevitable addition to the deficit even if all individual and corporate taxes were doubled. 

An important question in reviewing health care policy proposals: what are these proposals trying to fix? In terms of cost and coverage, enhancements to our current health care system in the past year have resulted in tremendous progress on both fronts, with millions more Americans now eligible for affordable, high-quality health insurance. And even prior to passage of additional subsidies, individual markets were showing signs of improvement through lower premiums and increased issuer participation. Only four percent of marketplace enrollees had access to only one issuer, while more than three quarters had access to at least three issuers. This provided an ideal foundation for new subsidies to help individuals gain coverage. Altogether, the current health care system has lowered adult uninsured rates and reduced racial and ethnic coverage inequities in almost every state over the past decade. 

Of course, many Americans still need coverage, and we must solve this. But, we can address coverage eligibility through existing options. Starting over by creating a new government-controlled health insurance system will be duplicative of current health care law while simultaneously introducing a range of potential costs and consequences.  

At a time when our health care system is providing millions of Americans with improved access to affordable, high-quality health coverage and care, building on and improving our current health care system, where private coverage, Medicare, and Medicaid work together, is the future of health care. 

Lauren Crawford Shaver is the executive director of the Partnership for America’s Health Care Future.


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