Newsweek - USA (2021-03-12)

32 NEWSWEEK.COM

by expanding the CDC and directing more money
to state and local public-health agencies.
Much of what Biden hopes to do to improve
health can be accomplished by building on the
Affordable Care Act. Its central selling point has
always been making healthcare insurance more
accessible and affordable to the currently unin-
sured. Obamacare has not come close to solving
the problem of cost, however: by the end of 2019,
about two-thirds of the 20 million people eligible
for ACA-subsidized healthcare premiums still didn’t
buy insurance, most likely because the premiums,
co-pays and deductibles remained too high. Mil-
lions of other Americans didn’t take advantage of
the ACA’s extended eligibility for Medicaid, which
often pays for nearly all healthcare costs. It hasn’t
helped that 12 Republican-dominated states have
steadfastly refused to make those benefits available
to their residents, even though it would cost the
states little to do so.
To fix these problems, Biden has proposed in-
creasing the subsidies by about 20 percent, reduc-
ing the out-of-pocket costs of care provided by subsi-
dized plans, allowing the Medicaid-eligible to bypass
state barriers to signing up, and even setting up au-
tomatic enrollment in Medicaid for eligible families
when they enroll students in public school. His ad-
ministration’s stated goal is to get 97 percent of the
U.S. public covered by private healthcare insurance,
a government insurance plan—the so-called “public
option”—or by Medicare and Medicaid, up from 91
percent today.
What might ultimately have an even greater
impact on Americans’ health is the way in which
Obamacare could help push much of the health-
care system away from fee-for-service payments.
The goal would be to move the system toward
health-maintenance or “capitated” approaches that
financially reward healthcare providers for pre-
venting illness instead of treating it. That’s usually
accomplished by paying providers a set per-patient
fee every month regardless of how much or how
little treatment they have to provide. Private health-
care providers and insurance companies have long
resisted this approach because they currently make
so much money by charging heavily for the exten-
sive care many patients need.
That move could be accomplished, says Freiden,
by directing the CMS, the federal agency that

IMPROVEMENTS

IN THE HEALTH

INFRASTRUCTURE

WILL IMPROVE

THE QUALITY

OF LIFE. AND

THEY’D PROBABLY

COST LESS THAN

HEALTHCARE DOES

NOW. THAT MAKES

THEM A GOOD DEAL.”