The 2028 Health Care Transformation Act

Abstract: The expansion and improvement of health insurance and health care, priorities of the Democrat party, were not central to the 2024 presidential campaign. The inability of Democrats to prioritize health care stems from the deep divisions inside the Democrat party on how to move forward and from problems with both the progressive and centrist approaches to health care reform. The progressive proposal for Medicare-for-all is deeply flawed, would be highly susceptible to budget cuts if the nation’s debt to GDP ratio continues to grow, and does not resonate with voters. The centrist proposals adopted during the Biden years did not substantially improve health care or insurance outcomes.

The 2028 health care proposals facilitating continuous affordable health insurance coverage and by eliminating abusive monopolistic-driven actions by private health insurance companies will result in substantial improvements to health insurance and health care outcomes. The 2028 health care proposals include –

(1) Employer subsidies of state-exchange health insurance enabling workers to keep continuous health insurance when unemployed or during job transitions,

(2) Partial subsidies of expensive health care cases insured by state exchange health insurance plans to reduce insurance plan risk and cost of state exchange policies,

(3) Additional regulations on insurance companies restricting surprise medical bills, eliminating arbitrary denials of medical claims, and improving the adequacy of health care provider networks,

(4) Improvements and expanded use of Flexible Savings Accounts to reduce hardships caused by high and increasing out-of-pocket health care costs.

Introduction:

The Democrats used to have a huge advantage with the American people on the issue of how to improve and expand health insurance and health care in the United States. The ACA created a path towards coverage for people without employer-based health insurance even if they had pre-existing conditions. The program is now so popular Republicans have stopped calling it Obamacare.

The major issues of the 2024 political campaign -- inflation, immigration and the border, and taxes -- did not include the expansion and improvement of health care. Democrats did not prioritize health care, despite their previous record and energy on this issue, the Republican’s unsuccessful attempt to eliminate the ACA and Trump’s almost complete lack of interest in the topic. During the 2024 presidential debate President Trump acknowledged that he had “only a concept of a plan” on how to replace the ACA and improve health care in the United States.

It is now apparent that the primary objective of the Trump Administration is the continued reduction of tax burdens at the expense of many government programs, including reductions to Medicaid and the elimination of the expanded premium tax credit for insurance purchased on state exchanges. The Democrat party is unified both in its support of Medicaid and the expanded premium tax credit, however, there is no Democrat party consensus on how to further expand health insurance coverage and improve health care outcomes.

Fifteen years after the enactment of the ACA myriad health care and health insurance problems still exist and some have worsened.

· Around 8 percent of the population remains uninsured,

· People reliant on employer-based health insurance lose coverage when unemployed,

· People unable to afford insurance premiums have inadequate coverage or are uninsured,

· Surprise medical bills, despite some progress, still exist.

· Narrow network health plans often lack access to specialists and hospitals.

· Insurance companies denied 850 million service request based on a finding of lack of medical necessity,

· High out-of-pocket health care costs cause many people to forego necessary health care procedures and services or divert funds from retirement savings.

The Democrat party does not have a clear, unified, economically viable response to these problems.

Lack of a viable unified Democrat approach to health care reform:

The Democrat party’s failure to expand on and improve the ACA and capitalize on its natural political advantage of the health care issue stem from three factors – (1) deep disagreements on the future of health care and health insurance in the United States between progressive and centrist health plans, (2) unrealistic aspects of progressive proposals which basically eliminate the current health care system in the United States and start over, and (3) the relatively small amount of progress on health care during the Biden