The Urban Institute released a healthcare proposal on May 14th, to expand upon the Medicare Program and ACA Marketplaces.  The Healthy America program “combine[s] improved financial assistance, an improved public [insurance] program with a broad provider network, provider payment rate caps to boost insurer participation and counteract the monopoly power of health systems in some areas, autoenrollment for very low-income people, and a new tax penalty for uninsured people.”[1]  Through a combination of increased taxes (payroll, sin, deductions, etc.) and repurposed Medicaid and Medicare payments, the Urban Institute outlines how paying for Healthy America will compare to paying for projected healthcare costs under the ACA as it currently stands.

The title of this proposed program, “Healthy America,” conflates having health insurance with improved physical health.  According to a 2008 study in Oregon with Medicaid recipients, having health insurance does not make a person healthier. [2] However, participants reported having an improved quality of life and better perceived sense of physical wellbeing.

Here’s the catch: combining the ACA individual market and Medicaid forms a greater risk pool.  Americans, however, are not healthy.  According to the CDC, 70.7% of adults are overweight (including obese people) and 37.9% of adults are obese. [3]  Expanding the risk pool for a proposed main source of insurance in the US to include the Medicaid claim pool will not improve claim utilization for the joint pools.  The Healthy America program authors state, “to boost enrollment in Healthy America and increase the size and diversity of its health insurance risk pools, people receiving SNAP and TANF payments would be automatically enrolled.” [1]  Individuals with low financial means tend to purchase the lowest-cost food available, which tends to be the most nutrient-deficient food available (i.e., fast food).  SNAP and TANF recipients tend to live in food deserts, places without healthy options, and they may not have the education to know how to choose healthy foods.  While having insurance may contribute to peace of mind, health insurance does not entail healthy lifestyle education or the breaking down of barriers to creating a healthy lifestyle.

The answer to rising healthcare costs is not expanded access to insurance, though expanded access to insurance is a desired accomplishment in this ACA, Medicaid, Medicare, employer-sponsored world.  Unhealthy society is a self-created problem.  The problem is “US.”  In Dr. Steven Aldana’s words, we are the “culprit and the cure.”[4]  Before we concentrate more energy as a country on “fixing” health insurance, we should focus on fixing our collective physical, mental, emotional, and financial health, first.

As in a previous article for BNA, to quote Pogo, “We have seen the enemy, and he is us.”  The US spends collectively $3.5 trillion on healthcare. [5]  That is $10,000 per capita, on average, one of the largest expenditures in the world. [6] We, as a collective whole, can cut that in half by focusing on what matters to us as human beings and not special interests and the status quo. If the US saved 40-50% of that healthcare expenditure, our country’s deficit would dissipate at an extremely rapid rate.  That would make us all healthy, more productive, and happier.  Just a thought.  Let’s stop stuffing our faces and let’s learn to live healthy lives, because the current paradigm is not sustainable and we will ultimately destroy ourselves because we can.  We’re Americans.  We can do anything…


[1] Linda J. Blumberg, John Holahan, Stephen Zuckerman, “The Healthy America Program: Building on the Best of Medicare and the Affordable Care Act,” Urban Institute, 14 May 2018,,

[2] Lecia Bushak, “90% of Americans Now Have Health Insurance: Does Having Coverage Make You Healthier?”, Medical Daily, 12 August 2015,

[3] Centers for Disease Control and Prevention, National Center for Health Statistics: Obesity and Overweight,

[4] Steven Aldana, The Culprit and the Cure: Why Lifestyle is the Culprit behind America’s Poor Health (Mapleton, UT: Maple Mountain Press, 2004).

[5] Yasmeen Abutaleb, “U.S. Healthcare Spending to Climb 5.3 percent in 2018: Agency,” Reuters, 14 February 2018,

[6] “Per Capita Healthcare Costs – International Comparison,” Peter G. Peterson Foundation, 8 May 2018,

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