A practical path to align affordability, transparency

As Washington debates whether to extend enhanced Affordable Care Act (ACA) subsidies, the real issue has been strangely overlooked. The right question isn't how much the government should contribute toward premiums, but how those subsidies are structured and how families are allowed to use them. That's where the ACA needs repair, and where recent Republican proposals, including ideas from Sen. Bill Cassidy, MD (R-La.), and Sen. Rick Scott (R-Fla.), point toward something constructive.

President Trump recently asked why Americans aren't simply given money to buy healthcare on their own. It's a fair question. The ACA's subsidy structure is so opaque that enrollees rarely see or feel its value. Subsidies flow to insurers through complex formulas, not to households in ways that encourage smart decisions or long-term financial security.

If we want the ACA to be sustainable -- for households, taxpayers, and insurers -- we need to modernize the subsidy architecture, not just extend it.

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