Fixing the Affordable Care Act -Again

The Affordable Care Act is in trouble. While 11 million people getting Medicaid are happy with it, those who have to pay for it aren't. Individuals without health care coverage must either choose a private insurance plan whose price increases every year, because insurers have a captive audience, or must pay a fine. For those who buy coverage, one in five have only one company to choose from. That means they have no choice at all. Insurers are dropping out because they have finally realized that they would need 10-20 healthy applicants to pay for one with serious conditions. Five percent of the population use 50% of out heath care costs. There are 19 states refusing to extend Medicare coverage to our most needy. Neither the Democrats nor the Republicans seem able to fix these problems. It's not that hard. Here is the solution.

First make signing up ACA voluntary. Insurers will no longer have a captive audience and will have to compete for healthy applicants. This will bring down the costs.

Make insurers able to reject any applicant for medical reasons. This will increase their profit margin and bring insurers back in the market. It will reduce the need for the government to give them $70 billion to cover their losses. Also let them offer a scaled down plan to cover necessary hospitalization, drug costs, lab tests, and doctor visits. And insurers must stop using deductibles.

Let everyone who is rejected for medical reasons be eligible for the "public option" which would be 100% federally funded as is Medicare with a share of cost depending on income The states cannot opt out just as they cannot opt out of Medicare. This would mean that 100% of our neediest will have coverage and that every American who wants or needs coverage would have it at affordable prices.

Also the government should use its leverage to reduce drug costs that are excessive. Most are very inexpensive but some are ridiculously high.

This will cost the government more but would be offset by eliminating the $70 billion subsidy to insurers and by reducing $100 billion that are spent for waste and fraud by $10 billion a year.