ACP calls for public insurance option; will research viability of Medicare for All

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A new position paper by the American College of Physicians says Congress must strengthen the Affordable Care Act (ACA) by creating a public insurance option and expanding Medicaid coverage in all 50 states.

In addition, the ACP’s leaders said last week they plan to embark on a wide-ranging project to recommend a way forward on healthcare in the United States. They will include a viability study on Medicare for All, which has gained popularity among voters and Democratic presidential candidates as the ACA continues to face political and legal challenges nine years after it became law.

“The ACP is committed to universal coverage,” said Bob Dougherty, the ACP’s senior vice president of governmental affairs and public policy. “For too long, we feel we have been playing defense and reacting. We decided it’s time to look at if we could reinvent the healthcare system, what would it look like?”

Dougherty said the project would take an evidence-based analysis of what’s working well in healthcare and what’s not, and would take the same tact when exploring insurance options for the future, which would range from single payer to ACA public options to coverage protections building on the existing healthcare system.  The college will have more details on the project later this year.

In the shorter term, Dougherty and ACP leaders are concerned about a legal challenge to the ACA in Texas. In that case, the U.S. Department of Justice is seeking to challenge the legitimacy of the entire law. 

Dougherty said the ACP believes the Trump administration is using a “dubious legal argument” and if the case ends in the White House’s favor, it will eliminate protections for pre-existing conditions, wipe out the Medicaid expansion, and shut down the Center for Medicare & Medicaid Innovation, which develops practice and payment models to help physicians and healthcare organizations transition to value-based care.

“There would be no replacement plan,” Dougherty said. “It would create absolute chaos. We are really worried and concerned about what would happen.”

And so the position paper, which will be published tomorrow in the Annals of Internal Medicine, makes a case of bulwarking the ACA. The paper, authored by Sue S. Bornstein, MD, and Ryan A. Crowley, calls to:

• Expand Medicaid in all 50 states.

• Create a public insurance option to “ensure enrollees have access to a variety of coverage options in their area.”

• Have federal or state government ensure all patients are enrolled in coverage, either by creating an auto-enrollment program, instituting a penalty for failing to enroll and/or some form of individual mandate.

• Increase tax credits to help patients better afford ACA marketplace coverage.

• Limit the sale of individual market plans that do not comply with ACA regulations.

• Increase and provide sustained funding for marketing, outreach, and patient enrollment assistance.

“The ACA has made health insurance accessible and affordable for millions of Americans, but many remain uninsured or burdened with unaffordable coverage,” the authors write in the paper. “Adopting these policies will be a step toward realizing what has been an unachievable goal: affordable, comprehensive insurance for all.”