Now that Obama has won reelection, the administration will move forward quickly to sponsor at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state. The national plans will compete directly with those of other private insurers and may offer significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the Office of Personnel Management, the agency that manages all the plans for federal employees. Under the Affordable Care Act (ACA), at least one of the nationwide plans must be offered by a nonprofit entity. Insurance experts see an obvious candidate for that role: the Government Employees Health Association, a nonprofit group that covers more than 900,000 federal employees, retirees, and dependents.
It seems a number of Republican governors have stubbornly refused to start planning for the state-based health exchanges, so the federal government will do it for them. However, some governors simply refused to act before the national election; undoubtedly some will decide to implement the state-based insurance exchanges. This was always an option in the ACA, although a little known one.
Will opposition to President Obama’s signature healthcare act fade now that he has gained a second term? Not a chance! So what could the Republicans do to undermine “Obamacare” with a Republican House of Representatives, a Democratic Senate, and Obama back in the White House? Budget reconciliation could almost certainly be used to amend or repeal ACA provisions that directly affect outlays or revenues of the United States, such as the Medicaid expansions, premium tax credits, or individual responsibility provisions. It could not, however, be used to change the insurance market reforms, such as the ban on health-status underwriting or the preexisting conditions clause ban. Moreover, ACA features that have already been implemented would be difficult, if not impossible, to roll back. Keeping adult children on their parents’ plan until age 26, eliminating preexisting conditions for children, closing the prescription drug donut hole for seniors, eliminating lifetime maximums—these are just a few of the more popular provisions.
And, much to the joy of progressives, the two new nationwide health plans offer alternatives not only to citizens of states that refuse to implement state-based health insurance exchanges, but also as practical alternatives for those who live in states dominated by only one or two insurance companies. It’s about as close to a one-payer system as we can get without offering a “Medicare for everyone” option.