Policy Options to Increase Health Care Coverage and Affordability: Comparing Enhancements to the Affordable Care Act and a Public Option

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[co-author: Sabiha Quddus]

The health care platform of President-elect Joe Biden aims to expand insurance coverage to the majority of Americans and lower health care costs for consumers. To accomplish these goals, Biden’s platform proposes enhancing the ACA, lowering the age of eligibility for Medicare, and introducing a government-run public option. With all new policies come trade-offs, and as policymakers seek to understand the possible effects of new proposals, they should ensure adequate consideration of coverage gains, costs, and the extent to which such proposals would improve the system or upend it.

We analyzed key provisions of Biden’s health care plan to determine the impact these changes would have on the uninsured rate and the broader health care system. We also examined how Biden’s proposed policies compare to the opportunity under current law to reduce the number of uninsured by expanding Medicaid in all 50 states. The analysis revealed that the Biden plan’s ACA enhancements, coupled with full Medicaid expansion, could lead to substantial coverage gains while preserving competition in the market and choice for consumers. However, the public option could upend the private insurance market, reducing choice for consumers while creating financial challenges for providers who would suddenly face an influx of patients on government plans with lower reimbursement rates.

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