The Patient Protection and Affordable Care Act: An Analysis of Options

April 2017

This policy memo evaluates several policy options which would strengthen and improve the Affordable Care Act (ACA), without dismantling it. The key problem is that the cost of health insurance has risen dramatically for consumers who rely on the Affordable Insurance Exchanges, while private insurers leave the marketplace. Costs are set to rise by an average of 25% in 2017. Currently, political momentum is in favor of a repeal of the ACA, which would have serious consequences. However, the following options could fix the problems currently associated with the ACA (a general public health insurance option, an expansion of Medicaid and Medicare, Reinsurance and Risk Corridor programs, and increasing the individual mandate tax penalty) without carrying out a harmful repeal. The general public option is ultimately recommended as the most effective way to control the cost of insurance on the Exchanges while keeping government costs at a manageable level and not reducing the insurance rate.