United Way’s ask of President Trump, House Speaker Paul Ryan (R-WI) and his Congressional colleagues is that any changes to our healthcare laws must improve on existing healthcare coverage, protect Medicaid from harmful structural changes and leave intact all consumer protections for all Americans. It may sound like a tall order, but it can be done, and that is the task for Speaker Ryan, President Trump and other Congressional leaders who have vowed to replace the Affordable Care Act with something better.

With that in mind, let’s look at the GOP’s proposed new health insurance law, the “American Health Care Act” (AHCA), sponsored by House Speaker Paul Ryan and championed by President Trump.

Last month, the world lost one of its greatest champions in human development and global health, Hans Rosling. Among other things, Mr. Rosling became internationally famous for visualizing complicated data and making it understandable, interactive and engaging for all audiences (even if it meant proving we are often no smarter than a chimpanzee). He taught us that despite all of the world’s ongoing challenges, we have made great social progress over the past several decades. Take for instance that:

Now that Speaker Paul Ryan has introduced the Republican proposal to repeal and replace the Affordable Care Act (a pair of bills referred to as the American Health Care Act), it would be instructive to look back to 2009, the last time health insurance reform was on the table, to see what directions health reform may take.

Back then, 49.9 million Americans, or about 1 in 6, were uninsured; health care premiums for Americans who had coverage were increasing by double digits every year, and Americans paid more for health care and got worse results than citizens in any country we would consider our peers.

For the second time in 8 years, America’s elected leaders are grappling with the thorny problem of how to improve health coverage and care for all Americans.

This time will be the same in one critical respect - the simple, unavoidable market realities to providing real access to health coverage for people who aren’t able to obtain coverage from an employer. 

This will again be a free market issue – whatever its faults, the Affordable Care Act (ACA) was firmly built around preserving a central role for private insurers to provide coverage and for consumers to have choice of plans and doctors. This pro-market nature of the ACA has been obscured by all the politics surrounding it.

Also, we need to take luck into account, as the great conservative economist Milton Friedman observed. None of us know which of us will be sick in the future, or which of us may lose our jobs. By its very nature, insurance redistributes the burdens of the unfortunate few across the many who are more fortunate. That’s built in, that’s how insurance works.

The upshot is that to expand health coverage in a private insurance market, we need to employ three interdependent tools, like the legs on a stool:

1. Require insurers to offer coverage to everyone, even if they have a pre-existing condition;
2. Require/incentivize younger, healthier people to buy into the insurance pool, even though they might otherwise choose not to buy insurance and;
3. Provide subsidies for lower income people who earn too little to pay the full cost of their premiums but earn too much above the poverty line to receive fully-subsidized health coverage

California has made huge strides in recent years to ensure more families and children are healthy and excel in life, particularly by increasing access to health coverage. The state has reduced the number of uninsured children from 2 million in 1999 to just over 100,000 today who are eligible but yet to be enrolled. The number of children in California with health coverage is at 97 percent, an all-time high. This is not the time to turn back the clock. If their parents lose coverage, children are at risk too. 

Yet members of Congress are proposing to do just that. Policy makers in Washington intend to repeal the Affordable Care Act (ACA) without a concrete plan to replace it – an ill-advised scheme that would have unprecedented consequences according to a new report from the Urban Institute.