Discussion of the Affordable Care Act often incites fear, confusion, and anger in people both for and against its passage.
Despite the political challenges, it’s very clear that the new administration and Congress are moving forward on their promise to repeal and replace the Affordable Care Act (ACA). This gives them a chance to fix the ACA’s weaknesses, while preserving and building on what it got right.
Guiding their reform should be the principles that healthcare should be accessible to every American, be high quality, and be affordable. Upholding all three principles means, first and foremost, enacting policies that better harness market competition. In countless industries from manufacturing to services to retail, market competition works, delivering more value to more people. But in healthcare, structural shortfalls of the market stifle choice and competition and drive up cost.
Policymakers should retain and improve the ACA’s existing health care exchanges as one option for access to health care plans. To foster competition and choice, they should open the exchanges to all individuals served in the “natural” healthcare market which could reach beyond state lines — not just the ACA’s strict state boundaries. As a result, many healthcare consumers would benefit from pricing unique to their respective area (consider the cost of doing business in New York City versus the state’s rural areas). This reform would change the status quo “cookie cutter” policy, in which only one exchange must serve an entire state but not exceed its boundaries, even into contiguous metropolitan areas.
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