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Health care reform law offers platform to build on



Change is always a big theme in politics, and while the status quo is not necessarily something to be preserved, some of the radical changes now being proposed by politicians should give employers pause.

The U.S. primary election season is coughing up all kinds of ideas that candidates hope will appeal to their parties' faithful but will likely evaporate or be moderated when the presidential election gets underway.

But there are certain proposals that look like they may have staying power. President Barack Obama's signature legislation, the 2010 health care reform law, has long been criticized by politicians on the right, many of whom seek to repeal it, but now it is running into trouble on the left, too. Sen. Bernie Sanders, I-Vt., appears to view the Affordable Care Act as better than nothing, but he wants to replace the reform law with an ambitious plan that would provide Medicare to all. While we await full details, the introduction of what would in effect be a single-payer system would include some sizeable tax hikes for individuals and corporations.

Regardless of where you stand on how health care should be paid for, there is something to be said for holding off on any significant changes until we see exactly how the ACA plays out. From the public policy point of view, early signs are encouraging, such as the big fall in the number of uninsured since key health care reform law provisions, such as federal premium subsidies for the lower-income uninsured, went into effect. While the out-of-pocket expenses for individuals obtaining coverage in the public exchanges can be high, especially for the cheaper plans, that is generally in line with the cost-shifting trend taking place with employment-based health care plans.

And the law is not undermining the employment-based system that historically has covered most workers in the United States.

Employers are cutting benefits, such as moving to higher-deductible plans, to hold down costs, but most that offered coverage in the past are maintaining coverage for their employees. That's a situation that's likely to continue in the current economy as health care coverage remains a key employee benefit that many employers need to offer to attract and retain workers.

While there are plenty of things to criticize in the health care reform law — the Cadillac tax, for example, clearly deserves lawmakers' attention — that and other issues can be handled by adjustments to the law rather than by repeal or replacement.

While I understand Sen. Sanders' goals — true universal health care coverage rather than coverage for just a large majority of people — I doubt the United States is yet ready for the hike in taxes that would be required to pay for it or the massive shock to the health care system that would be required. Radical changes are all very well, but moving them from the stump to reality can be a long process.