EDITOR: The ACA subsidies that Republicans allowed to expire this year were expanded subsidies that were added to address the COVID crisis. Continuing to extend these expanded subsidies ad infinitum is not a viable solution which does not address the underlying issue of rising healthcare costs themselves, much less premium hikes. Rather, continued extension of these expanded subsidies is a Band-Aid to the rising premiums that are due to rising costs.
A solution that will address the issue of rising premiums - and will have an impact of lowering costs - would be to add a Public Option to every ACA exchange. Not only will this address the issue of rural exchanges with only one private insurance company offered but will force competition that will lower premiums and result in fewer coverage denials.
The Public Option would use (or parallel) the Medicare system, which by its shear market share and bargaining power would allow coverage at a much lower premium than the private insurers are currently offering on the exchanges. This would also force competition - likely to the point where most use the Public Option, and the private insurers would be able to sell supplemental coverage on the exchanges in addition to full policies for those not choosing the Public Option.
Since the payouts for supplemental insurance would only be ~20% of the costs rather than up to 100%, private insurers could reorganize to focus on selling supplemental insurance policies and be able continue operating with a fair profit margin.
Congress should extend the expanded subsidies until such time that the Public Option can be implemented and offered on every ACA exchange. Once that is done, all ACA subsidies could be allowed to expire, because a better and more effective solution would then be in place.
Daniel Wells,
Tracy, CA