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Those Devilish Details (Gwen Moritz Editor’s Note)

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A new Congress and the now undeniable commencement of the 2020 presidential election campaign season mean that the most personal political topic is inching its way back into the news: health care.

So much has happened in the past two years that it’s easy to forget that Donald Trump ran for president on more than a declaration that Mexico would pay for a big, beautiful concrete wall and his admiration for Vladimir Putin. He also promised to repeal the Affordable Care Act and replace it with better insurance for everyone at a fraction of the cost. That kind of talk, along with his promises to protect the entitlements that conservatives traditionally disdain, helped him rise to the top of the Republican field.

But having a plan is not one of President Trump’s strong suits (as underscored by his ever-changing vision of a border wall), and he didn’t care enough about Obamacare to understand how it affected his own employees. “Nobody knew that health care could be so complicated,” he said, after spending a year and a half running on the issue.

So it was no surprise that he outsourced the replacement of the ACA to congressional Republicans, who, despite seven years of promises, didn’t actually have a plan either. (“I didn’t expect Donald Trump to win. I think most of my colleagues didn’t. So we didn’t expect to be in this situation,” U.S. Sen. Pat Toomey, R-Pa., confessed.)

Since the summer of 2017, when Sen. John McCain — scarred from surgery on the brain cancer that would kill him — turned his thumb down, health insurance largely slipped off the to-do list in Washington. Congress did get rid of the “individual mandate” — the requirement that everyone have health insurance or pay a penalty — and that gave Republican state attorneys general, including our Leslie Rutledge, an opening to argue that the entire ACA was then unconstitutional. They won a major victory in federal court in Texas in December, but that ruling is stayed pending an appeal — by Democratic attorneys general naturally.

It wasn’t as noticeable in a noncompetitive state like Arkansas, but the availability of affordable health insurance was a major issue in the November midterm elections — especially among energized Democratic voters. It was such a big deal that Republicans actually claimed to be the champions of coverage for pre-existing conditions, as if they hadn’t repeatedly voted to kill that along with the rest of Obamacare.

The “blue wave” gave Democrats 40 additional seats in and control of the U.S. House of Representatives and seven new governorships, and it limited the gains Republicans made in the Senate despite the most favorable map in memory. Now congressional Democrats are focusing on their health care promises, as is the profilteration of Democratic presidential candidates.

Among the most common talking points is “Medicare for All,” but public reception to that idea depends, devilishly, on the details. To open up something like Medicare for anyone who wants it gets strong support from 49 percent and some support from another 24 percent, according to a January survey by the Kaiser Family Foundation. But replacing all private insurance with Medicare has virtually the same strong opposition (32 percent) as strong support (34 percent).

With the expectation of scare tactics from both sides of the Medicare for All debate, I’d like to once again recommend the idea of universal catastrophic coverage. It’s an idea that has been kicked around, including by conservatives, for decades: a mandatory, taxpayer-supported safety net that would, to quote economist Ed Dolan of the Niskanen Center, “offer protection from those relatively rare but ruinous healthcare expenses that are truly unaffordable.”

As conceived by California venture capitalist Kip Hagopian and Dana Goldman, a health care economist from the University of Southern California, UCC could be either government-run or sold by private insurers, and the deductible would be high but scalable depending on household income. (UCC would not replace Medicaid for the poorest.)

For those squeamish about the government completely replacing the private health insurance industry, the UCC concept offers this opportunity: supplemental private insurance to hedge against the high deductible for households that can afford it. “The premiums for such supplemental coverage would be far lower than policies now sold on the ACA exchanges, since the UCC policy would set a ceiling on claims for which the insurer would be responsible,” Dolan wrote in The American Conservative in 2017. “If the supplemental policies included modest deductibles or co-pays of their own, they would be more affordable still.”

Email Gwen Moritz, editor of Arkansas Business, at GMoritz@ABPG.com and follow her on Twitter at @gwenmoritz.
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