One of the reason that the Republican’s got such head wind on the repeal Obamacare idea, was that Democrats never had a proposal to build onto Affordable Healthcare Act and make it better. Any law – indeed any idea – has weaknesses that are exposed over time, and it is necessary to adjust plans to make them better over time.

The Affordable Care Act is great if you are poor and are living on the edge of poverty, but it does little to help middle class families or small business who don’t already have group insurance. I suggest greater subsidies and mandatory enrollment to overcome these problems:

1) Not enough subsidies for purchasing health insurance for small businesses and middle class families.

Health insurance should be affordable for everybody – and as inexpensive as possible to individual consumer. I think subsidies should be provided for anybody making under $250,000 a year that will make healthcare an inexpensive proposition – no more then $30-$50 for the individual and $50-$100 for the family each month. Even for middle class families, budgets are tight, and subsidy levels for insurance should make it possible for even middle class families to afford insurance.

Small businesses with fewer then 50 full-time should be able to pay for health insurance with a fully refundable tax credit. Even if a business made no profit, the government would pay the business to offer insurance. This would mean that providing health insurance to employees would be a free proposition to business, and there would be no excuse not to provide insurance to employees.

Both are expensive propositions. But health care is important, and we need to make sure everybody can afford health care, even if they are middle class or own a small business. In a country that produces nearly $20 trillion in economic value each year, we can afford to devote a couple hundred billion more to ensure people can afford the care they need.

2) The government should enroll everybody into a health insurance plan, even if they don’t sign up for insurance.

Right now, everybody has to sign up for an health insurance plan under the Affordable Care Act. But some people forgo this insurance, because they either can’t afford it in their budget, or don’t believe it’s necessary. Not having insurance puts those people at a lot of risk from sickness or injury, and can lead to financial catastrophe. I believe the government should automatically enroll people into an insurance plan.

Anybody who files taxes or visits a medical facility would be checked by the government to see if they had an acceptable Affordable Care Act plan. If they didn’t have a plan, the government would automatically enroll them into a Silver-level Affordable Care Act plan offered by a randomly selected insurer. The person would be then sent an insurance card, a statement of benefits, and a monthly bill for their coverage. If a person didn’t pay the the monthly bill, the insurer would be empowered to automatically deduct it from their wages or withdraw funds from their bank account.

Obviously, most people would prefer to choose their plan. This would be a lower cost option for individuals, then having the insurer get a court order to withdraw money from a workers’ wages. Most people who didn’t sign up for insurance immediately or pay their bills, quickly would choose to do so, to make sure they maximize their take home pay.

By automatically enrolling everyone, we would ensure nobody lacks coverage, and ensure even people who don’t want to sign up or participate are in the pool, paying their fair share. Should non-enrollees have a medical emergency, hospitals will know definitively that their patient has coverage, and that they will be reimbursed for their illness.

At Least the Affordable Care Act is Getting People Insured…

The numbers don’t lie. People, especially in states that did the Medicaid Expansion, have seen dramatic growth in coverage. We’ve made Universal Healthcare the law of the land. This means when people get sick or injured, they don’t have to fear bankruptcy or complete financial ruin — even if some of the plans offered on the marketplace aren’t as comprehensive as they should be.

But with increased subsidies and automatic enrollment, we can do better. Nobody should be left without health insurance.

Why Not Single Payer Healthcare?

There are many ways we can ensure universal health care. While not single payer, our universal health care system is providing financial protection and well being for most Americans. The Affordable Care Act got thousands of Americans the financial protection of health insurance, and ensures people will get the care they need to be healthy. I think it’s a system we can work with, especially if we increase subsidies to small businesses and middle class families, to ensure it is affordable.

Globally, only a fraction of Universal Healthcare Systems are single payer. But the important thing is they are making health care affordable for all.

Shown above:
1) Single Payer – Government pays all health care expenses (green)
2) Two-tier – Basic government healthcare system (e.g. Medicare in Canada) (yellow)
3) Insurance Mandate – Government requires all citizens to purchase insurance (blue)