Serving in Congress during the implementation of President Barack Obama’s Affordable Care Act, Republicans embraced the position of “repeal and replace.” Repeal the ACA, but replace it with what? The debate is front-and-center again, though the ground has shifted some. There is more support for the ACA. Even some Republicans are looking to temporarily extend COVID-era subsidies for ACA health plans. Other Republicans want Health Savings Accounts, so more money goes to individuals instead of insurance companies. Democratic leadership seeks an approach temporarily extending the expanded premium subsidies, during which the entire approach to health care can be rethought.

The late economist Martin Feldstein had the fix: Martin Feldstein proposed a voucher system in which everyone could purchase a health insurance plan covering health care expenses exceeding 15% of their income. This could be combined with HSAs if they prove popular with the public.