Saint Louis University Journal of Health Law & Policy

Document Type



Democrats continue to debate how to extend health insurance coverage to the remaining uninsured and improve the affordability and quality of coverage and care. Prior intraparty debates—over whether to build upon the Affordable Care Act, create a public option, or expand the Medicare program to all (or more)—have centered on how to best accomplish these goals and whether health care delivery should be mediated through public versus private payers. These are worthwhile debates, but the history of health reform suggests that private health insurers are here to stay. This Article accepts the premise that future coverage expansions will likely rely on private insurers. Assuming so, I argue that more attention must be paid to holding these entities accountable for the government-subsidized benefits they offer. While the Affordable Care Act ushered in reforms that have addressed many historic insurance industry abuses, additional accountability measures are urgently needed to ensure access to care, increase affordability, and advance equity. This Article identifies several policy options that would help achieve these goals and could constitute part of an updated, post-Affordable Care Act patient bill of rights. Looking ahead, federal and state policymakers must pair coverage expansions with accountability mechanisms to maximize taxpayer value in subsidizing private coverage across a range of public programs.