A Pathway To Consumer-Driven Universal Coverage.

Enrollment in the Marketplaces of the Affordable Care Act (ACA) has fallen short of original expectations, because the ACA's regulatory changes made coverage costlier for many Americans with incomes above 150 percent of the federal poverty level. There are ways to strengthen and expand the role of the individual market in providing affordable, personalized options to all nonelderly Americans. These include insured people in costly group plans, uninsured people in good health but without affordable options, those with preexisting conditions, and those who live in states that did not expand eligibility for Medicaid. A more robust individual market could expand coverage so that it would be more sustainable than the status quo. Much as the authors of the Affordable Care Act drew on Massachusetts reforms signed into law by Gov. Mitt Romney (R), market-oriented health reformers should learn from the ACA and Medicare's private insurance programs in order to build a personalized, consumer-driven path toward universal coverage.