In a commentary for The Daily Wire, Walter Myers III argues that the Affordable Care Act, known as Obamacare, has expanded coverage but failed to solve healthcare affordability. He traces the system’s historical roots, criticizes regulatory structures, and proposes market-based reforms to lower costs, amid deep partisan disagreement over the law’s future.
The opinion essay criticizes the structure of the American health insurance system by contrasting it with the more visibly competitive markets for auto and home coverage. Walter Myers III writes that, unlike those sectors, most health insurance plans cannot be purchased across state lines because of state-based regulation, which he argues contributes to fewer choices and higher prices for consumers.
Myers traces what he calls a “uniquely American challenge” to World War II, when the Franklin D. Roosevelt administration imposed wage and price controls to curb inflation. Employers, unable to raise salaries, increasingly offered health insurance as a fringe benefit, intertwining coverage with employment. According to his account, this legacy leaves many people exposed when they change or lose jobs, particularly those whose incomes are just above Medicaid eligibility thresholds.
The Affordable Care Act, enacted in 2010 and commonly known as Obamacare, sought to expand coverage and improve access, especially for people with preexisting conditions who often could not buy individual coverage before the law. Myers acknowledges that the ACA broadened insurance coverage to millions, particularly through Medicaid expansion and the creation of insurance marketplaces. But he contends that for people who do not qualify for federal subsidies, premiums and deductibles have risen to the point that some families face monthly premiums in the thousands of dollars and high out-of-pocket costs, making their insurance feel more like catastrophic coverage than comprehensive protection.
He argues that several structural problems help explain why costs remain high. First, Myers says, the ACA left in place state-level limits that keep most health insurance markets confined within state lines, which he believes dampens competition. Second, he points to the law’s requirement that plans cover 10 categories of “essential health benefits,” saying this forced many people off cheaper plans that did not meet the new standards. He cites President Barack Obama’s assurance during the law’s rollout — “If you like your plan, you can keep your plan” — as having proved inaccurate for many consumers whose noncompliant plans were discontinued.
Myers also criticizes how subsidies and plan structures work in California. He notes that the state promotes the fact that most subsidized enrollees receive mid-tier Silver plans but argues that this comes at the expense of people enrolled in lower-cost Bronze plans through cross-subsidization built into the marketplace, a design he describes as unfair.
Another concern raised in the essay is price opacity. Myers writes that negotiated rates between insurers and healthcare providers are typically hidden from patients, making it difficult for them to learn the true cost of procedures or to comparison-shop. He argues that this lack of transparent pricing weakens competitive pressure on providers and insurers.
The essay also blames political stalemate for the lack of broader change. Myers portrays many Democrats as viewing the ACA as a step toward more expansive government-run models, such as single-payer or Medicare-for-all systems, and as framing healthcare as a universal right. He counters that, in his view, insurance — whether for health or property — is fundamentally a contract, not an entitlement. Republicans, he writes, have strongly opposed the ACA for years but have focused heavily on repeal efforts rather than developing and advancing detailed replacement plans centered on portability, transparency, and consumer choice.
Myers lays out several reforms he believes would move the system toward a more competitive, market-driven model. He calls on Congress to override state restrictions that prevent insurers from selling policies across state lines, arguing that this would broaden risk pools and foster competition. He urges policymakers to require clear, upfront prices from providers based on the negotiated rates that already appear on patient statements, so patients can see and compare costs before receiving care. He also argues that the federal requirement to cover the 10 essential health benefits should be eliminated, allowing consumers to tailor coverage more closely to their needs, while keeping protections for people with preexisting conditions by using separate high-risk pools similar to those used in auto insurance markets.
Ultimately, Myers advocates decoupling health insurance from employment. In his view, individuals should own their coverage independent of any single employer, while companies could still choose to contribute to or enhance employees’ existing policies as a benefit. He argues that such changes — along with breaking up what he sees as monopolistic structures and improving transparency — are necessary for the United States to achieve a health insurance marketplace as dynamic and affordable as those that exist for auto and home insurance.
Myers is a Southern California-based senior fellow at the Discovery Institute. The essay was published by The Daily Wire, which notes that the views expressed are those of the author and not necessarily those of the outlet.
