Now that the Affordable Care Act seems likely to survive the Republican effort to repeal and replace it (for now), many liberals are mobilizing around the idea of a "single-payer" insurance system, built off Medicare, the federal program that now covers the aged and disabled. Among the liberal luminaries who have signed on or expressed support are US Sens. Bernie Sanders, Elizabeth Warren, and Kamala Harris.
I have a better idea: Medicaid for more! Contrary to the rhetoric on Capitol Hill, Medicaid, not Medicare — or, for that matter, the ACA exchanges — offers the most plausible path to an American version of affordable universal coverage.
Medicaid has grown incrementally and continuously since the late 1980s, under both conservative Republican and liberal Democratic administrations. That pattern continues today, and more than a dozen Republican governors have been fighting to protect Medicaid expansions created by the ACA.
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Looking ahead, there are opportunities for bipartisan efforts to expand Medicaid's role as the nation's medical safety net. We should encourage the 19 states that have so far rejected the ACA Medicaid expansion to embrace it. We should use Medicaid as the public insurance safety net in markets lacking adequate private competition. We should encourage states to allow residents to buy into Medicaid.
Finally, we should push a future administration to nationalize such a buy-in program.
Some states have begun to recognize the wisdom of the Medicaid buy-in approach. Nevada came close to adopting such a strategy: In June, Republican Gov. Brian Sandoval waited till the last minute before vetoing a bill that would have let Nevadans buy into Medicaid — but even as he did so, he said it was an idea worth considering. Now Massachusetts is exploring the option. So is Minnesota. More states should join them, as the idea is both good policy and good politics.