Skip to content
  • About
  • Contact
  • Contribute
  • What Physicians Say
  • My Book
  • Careers
  • Podcast
  • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
  • About Kevin Pho, MD, Founder of KevinMD
  • Aging and dementia: what physicians say, in their own words
  • Artificial intelligence: what physicians say, in their own words
  • Be heard on social media’s leading physician voice
  • Cancer: what physicians say, in their own words
  • Children’s health: what pediatricians say, in their own words
  • Contact Kevin
  • COVID-19: what physicians wrote as it happened
  • Custom enhanced author page pricing
  • Diabetes and obesity: what physicians say, in their own words
  • Direct primary care: what physicians say, in their own words
  • DMCA Policy
  • End of life: what physicians say, in their own words
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words
  • Heart disease: what physicians say, in their own words
  • Immigration and medicine: what physicians say about immigrant doctors and immigrant patients, in their own words
  • KevinMD influencer opportunities
  • Medical errors: what physicians say, in their own words
  • Medical ethics: what physicians say, in their own words
  • Medical malpractice: what physicians say, in their own words
  • Medical school: what students and physicians say, in their own words
  • Mental health: what psychiatrists and physicians say, in their own words
  • Nursing: what nurses and physicians say, in their own words
  • Opinion and commentary by KevinMD
  • Opioids: what physicians and pain patients say, in their own words
  • Physician burnout speakers to keynote your conference
  • Physician burnout: what physicians say, in their own words
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician personal finance: what physicians say about their own money, in their own words
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Physician suicide: what physicians say, in their own words
  • Physicians and administrators: what physicians say about who runs medicine, in their own words
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Primary care: what physicians say, in their own words
  • Prior authorization: what physicians say, in their own words
  • Privacy Policy
  • Private equity and corporate medicine: what physicians say, in their own words
  • Race and medicine: what physicians say, in their own words
  • Recommended services by KevinMD
  • Residency: what residents and attendings say, in their own words
  • Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words
  • Subscribe to the KevinMD enhanced author page
  • Subscribe to the newsletter
  • Surgeons and surgery: what surgeons say, in their own words
  • Take-home messages: what physicians say when asked to leave one
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • The electronic health record: what physicians say, in their own words
  • Vaccines: what physicians say, in their own words
  • Violence against health care workers: what physicians and nurses say, in their own words
  • What physicians say: the KevinMD records
  • Women in medicine: what women physicians say, in their own words
  • Women’s health: what physicians say, in their own words

Obamacare isn’t a disaster. Failing to improve upon it would be.

Cedric Dark, MD, MPH
Health Policy
May 3, 2017
Share
Tweet
Share

Congress has returned to DC in the wake of the defeat of Paul Ryan’s American Health Care Act. And while shouting “repeal and replace” might win elections, this debacle proves that the American people will not tolerate their families, friends, and neighbors losing healthcare coverage just so rich people can get tax cuts.

Yet, Congress will certainly revisit health reform again. With the Republican caucus fractured, Paul Ryan should seek out the help of moderate Democrats to fix parts of the Affordable Care Act that would still achieve conservative policy goals.

Moderate Republicans and Democrats might find agreement in four key policy areas.

1. Reducing the burden of taxes and mandates. Republicans remain intent on repealing the ACA’s taxes and mandates.

First and foremost, the individual mandate is untouchable. Its existence has a strong policy purpose, and Democrats will never give it up. But the employer mandate is up for negotiation.

Research demonstrates that the employer mandate if repealed, would not result in significant coverage losses. On the contrary, more people might gain jobs, outweighing those who would have lost coverage. The math makes sense. The employer mandate should go.

Some other taxes that could easily be scrapped — and have even received bipartisan support in the past — include taxes on medical devices, the pharmaceutical industry, and health insurers. The costs of these taxes are merely passed onto consumers. Getting rid of them would provide relief to the people who actually face their costs, patients in our health care system.

2. Bridging the Medicaid gap. Nearly 3 million Americans make too much money to qualify for Medicaid, but not enough to purchase subsidized coverage from HealthCare.Gov. Since many politicians deride Medicaid in states like Texas, Florida, and Georgia, there is a better way to provide healthcare coverage to the poor. Congress should bypass recalcitrant state legislatures and governors and fund direct support for the poor to buy health insurance through the ACA’s Marketplaces.

An idea that has been floating around would allow people caught in this so-called Medicaid Gap to do exactly that — skip traditional state Medicaid plans in exchange for private coverage through HealthCare.Gov. Congress should change the law to allow Americans in states not expanding Medicaid to enter the ACA Marketplaces instead.

For Republicans, it would remove government from the day-to-day delivery of health care; for Democrats, it would ensure that coverage could be expanded regardless of the politics in 19 states yet to expand Medicaid.

3. Fixing the family glitch. Some workers get an offer of insurance that is affordable for individual coverage alone, but family coverage is too costly. Unfortunately, the ACA locks these families out of using federal subsidies to buy insurance. This is termed the family glitch. By altering the calculus determining affordability of family coverage, significant relief can be obtained for nearly 6 million people.

Although fixing the family glitch would not dramatically increase total numbers of people covered, allowing employees with unaffordable offers of family health insurance the ability to access Marketplace subsidies would be equivalent of providing over $1,000 of tax relief to millions of working American families.

4. Cutting costs with catastrophic coverage. Lastly, the cost of coverage must decrease. One way to improve on the cost is to open up the ACA’s catastrophic coverage option to all Americans, not just those who are under 30. The Trump Administration could immediately make this a reality for Americans simply by issuing hardship exemptions.

ADVERTISEMENT

Congress should then pass legislation increasing the maximum annual contribution limits for health savings accounts up to the level of the out-of-pocket maximum limit of $7,150 for catastrophic plans. This is crucial because current HSA contribution limits are less than half of this amount. By offering lower cost options, Congress could expand coverage and stabilize the ACA’s marketplaces.

Now is the time that Republicans admit that the ACA isn’t a disaster. Their failure to improve upon it, however, would be.

Cedric Dark is founder and executive editor, Policy Prescriptions.

Image credit: Shutterstock.com

Prev

Other jobs have strict rules on hours worked. So should doctors.

May 3, 2017 Kevin 11
…
Next

Widespread hype gives false hope to many cancer patients

May 3, 2017 Kevin 5
…

Tagged as: Health Policy and Public Health

< Previous Post
Other jobs have strict rules on hours worked. So should doctors.
Next Post >
Widespread hype gives false hope to many cancer patients

 

ADVERTISEMENT

More by Cedric Dark, MD, MPH

  • What a doctor felt when his neighbor was shot

    Cedric Dark, MD, MPH
  • A theological answer to our health care crisis

    Cedric Dark, MD, MPH
  • A path to universal health coverage in America

    Cedric Dark, MD, MPH

Related Posts

  • A specific way to improve our health care delivery system

    Lea Lefkowitz
  • Improve mental health by improving how we finance health care

    Steven Siegel, MD, PhD
  • Can the states fix our national health care disaster?

    Elisabeth Rosenthal, MD
  • Medicine is failing rural Americans

    Michael McCarthy
  • How health insurance contributes to our failing system

    Edward Hoffer, MD
  • Our health care system may be failing, but it isn’t broken

    Jeb Dunkelberger

More in Health Policy

  • The next child

    Medicaid managed care and the case for mutual stewardship

    Steven Merahn, MD
  • How to build a dementia care pathway, not a referral sheet

    Gerald Kuo
  • AI in prior authorization: 3 contract questions for 2027

    Matt Hasan, PhD
  • Private equity in medicine did not kill private practice

    Brian Hudes, MD
  • Why are fewer family physicians delivering babies?

    Frista Gradica
  • Local news and public health: the segment viewers missed

    Ronald L. Lindsay, MD
  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • 4 fibromyalgia myths the current evidence doesn’t support

      Kayvan Haddadan, MD | Conditions and Diseases
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI governance in health care has to reach the exam room

      Amanda Heidemann, MD | Health Technology
    • The Pennsylvania measles outbreak and the cost of forgetting

      Christine King, CRNA | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • 4 fibromyalgia myths the current evidence doesn’t support

      Kayvan Haddadan, MD | Conditions and Diseases
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI governance in health care has to reach the exam room

      Amanda Heidemann, MD | Health Technology
    • The Pennsylvania measles outbreak and the cost of forgetting

      Christine King, CRNA | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use Agreement
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Obamacare isn’t a disaster. Failing to improve upon it would be.
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...