Op-Ed: The ACA helped dampen the pandemic’s impact. Now it’s time for a public option

On the 11th anniversary of the Affordable Care Act, we should consider the next step
Maura Collinsgru

This week was the 11th anniversary of the Affordable Care Act being signed into law by President Barack Obama. Despite the best efforts of opponents, the law has expanded affordable health care coverage to nearly a million New Jerseyans and protected women, those with preexisting conditions, and others. Since 2013 the number of uninsured people in the state decreased by almost half.

The ACA clearly helped dampen COVID-19’s impact, but the pandemic also exposed the inequities and shortfalls that persist in our health care system. Hundreds of thousands of New Jerseyans still lack access to quality, affordable health care. In the midst of the pandemic, lawmakers responded by increasing funding for hospitals and COVID-19-related services and instituting short-term measures to increase access to coverage under the ACA and Medicaid.

President Joe Biden has delivered on his promises to increase access to testing and vaccines, expand health care and provide economic relief for businesses, families and workers who desperately need it. He recently signed the American Rescue Plan, which accomplished these things, plus laid the groundwork for an economic recovery over the coming months. The bill makes tremendous improvements to health care affordability and access, with additional premium subsidies including for unemployed health coverage, and incentives to expand Medicaid for states which have yet to do so. We are closer to ensuring universal access to quality affordable health care than we have been in decades.

In New Jersey, Gov. Phil Murphy took decisive action to improve access to coverage and affordability. The state launched its own health care exchange in late 2020 with more insurance premium subsidies available to low- and moderate-income families, funded by a state health-insurance assessment. A special COVID-19 open enrollment period was implemented through May 15, 2021, in New Jersey and across the nation. An increase in outreach and enrollment-assistance programs ensures more residents are educated on their coverage options, including lower-priced plans for those not eligible for ACA subsidies.

GOP pulling in the oppositive direction

Meanwhile, GOP leaders did not let up on their efforts to repeal, undermine, limit, and dismantle the ACA. Republicans in Congress and statehouses have repeatedly taken action to discourage ACA participation and limit protections for sick Americans. In 2017, congressional Republicans effectively nullified the ACA’s individual mandate by eliminating any penalties, then used that as the basis for a constitutional challenge to overturn the ACA in the Supreme Court.

Over the past four years, the administration of former President Donald Trump implemented numerous regulations that, among other things, shortened the open enrollment period, cut funding for ACA marketplace operations, withheld funds for low-income subsidies, and weaponized the public charge rule to punish immigrants who rely on programs like Medicaid to survive (a step later repealed by the Biden administration). These attacks destabilized the health insurance market and led to increased costs for consumers, and Republicans will not relent anytime soon.

Improvements to health care from the American Rescue Plan and the Biden and Murphy administrations have been crucial in our recovery from COVID-19, but further action is needed for meaningful progress. In the short term, the affordability improvements in health care exchanges should be made permanent, and Americans are desperately in need of prescription drug reforms within the year as prices skyrocket. In the long term, President Biden should deliver on his campaign position of a nationwide public option.

Ultimately these changes to the ACA are a bandage on a deeply flawed health insurance industry, which must be addressed systemically and holistically. In New Jersey, Gov. Murphy can and should implement universal coverage for all children with the Cover All Kids initiative.

The fight for universal health care requires vigilance; its opponents are powerful and will not desist. The American Rescue Plan is a long-awaited lifeline for millions of desperate Americans, but it is a short-term solution to a decades-old problem. COVID-19 exacerbated the inequities in our health care system, made even worse by Republican attacks, but those inequities predate the pandemic and will remain for years to come without more comprehensive change.

President Biden is delivering on his promise to guide us out of and provide relief from this crisis. Nevertheless, even pre-COVID, the status quo of our health care system was unsustainable. We need the public option.

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