California Gov. Gavin Newsom, D, wasted no time making a splash, announcing on Monday, his inauguration day, a major new health-care initiative that would make his state a leader in resisting Republican efforts to unravel the Affordable Care Act. Newsom's plan is a promising reform that other states - and, if Congress and the president ever come to their senses, the federal government - should consider.
As have many progressive politicians, Newsom has embraced a Medicare-for-all-like "single payer" system. But his opening health-care push is more practical, adding to the existing Obamacare framework rather than scrapping it for a more radical change. The governor would start by reimposing the individual mandate that congressional Republicans killed in 2017. As when the federal government requirement was still enforced, the state-level mandate would compel every Californian to carry decent health-care coverage or pay a penalty. Doing so would draw more people - particularly younger and healthier people - into the state's insurance pool, keeping average costs down for everyone.
Newsom does not stress the mandate so much as the carrots he would like to offer Californians to get covered. His plan would use revenue raised from reimposing the mandate to make insurance easier to buy. Federal subsidies currently help Californians who buy their coverage on the individual insurance market to pay their premiums - but only if they make less than a certain amount. Newsom would expand these subsidies with state funds. This could make a huge difference to a group of people Obamacare has not served very well - those who do not get insurance from their employers but also do not qualify for federal individual market subsidies. These people have borne the full brunt of premium volatility. Under the governor's plan, many of them would no longer have to, meaning fewer of them would choose to go without coverage. Again, drawing more people into the system would keep average costs down and increase the stability of the system as a whole.
The state must do something. About 10 percent of its nonelderly population lacks coverage. A study by UCLA and the University of California at Berkeley last year projected a steady rise, finding that Republicans' Obamacare sabotage and other factors would increase the uninsurance rate to 13 percent by 2023, with about 1 million more uninsured Californians, barring a policy shift.
Many details and much legislative wrangling await, but Newsom's initial push should get high marks. His two-pronged approach would go a long way toward stabilizing the Obamacare system nationwide. But with the federal government doing nothing helpful, states must act.
With a divided government, such a reform may not be possible in Virginia. But in Maryland, reimposing the individual mandate has already been discussed. Massachusetts has its own mandate and subsidy program, and it has the lowest uninsured rate in the nation. New Jersey, too, has a state-level mandate. Other states should follow suit.
The Washington Post