Searchlight Institute Proposes Universal Free Primary Care Ahead of 2028 Elections

As the 2028 Democratic presidential primary approaches, policy institutes are unveiling healthcare proposals for candidates. The Searchlight Institute has introduced a set of reforms titled "Making Health Care More Available," recommending that primary care services be made universally free.

This proposal suggests adding primary care as an eleventh essential health benefit (EHB) to those mandated by the Affordable Care Act, obliging insurers to cover these services without any out-of-pocket costs. However, it is essential to identify what percentage of current healthcare expenses involves out-of-pocket primary care spending. The proposal lacks clarity in defining primary care, thus referring to the Milbank Memorial Fund's Primary Care Scorecard definitions is necessary.

According to Milbank’s scorecard, primary care—when narrowly defined—encompasses general practice, family practice, internal medicine, pediatrics, and geriatrics, constituting 4.5% of total health spending. A broader view extends this share to 12%. Most expenses are covered by insurers, with out-of-pocket spending accounting for 0.6% to 1.8% of total healthcare spend. Expanding primary care coverage as proposed could lead to increased premiums, balancing insurers' costs.

The Searchlight proposal also features launching the American Health Gateway, a "nonprofit coverage option" designed to compete in the ACA exchange and Medicare Advantage markets, offering free coverage to low-income individuals in states without Medicaid expansion. While potentially serving 13.2% of the population, the actual uptake may be lower. The exclusion of the employer market and Medicaid MCO market presents concerns about comprehensive application.

The proposal suggests revisiting exchange plan subsidies to previous levels seen during the Biden administration, impacting only Medicaid-expanded states and excluding many exchange enrollees. Additionally, Searchlight proposes that policyholders could include non-related "loved ones" in their healthcare plans, with adjusted premiums for additional enrollees.

In its conclusion, Searchlight addresses systemic healthcare industry issues, aiming to reduce bureaucratic barriers and enhance access through technology and international resources. While these proposals target well-known challenges, the practical impact remains to be seen. The initiatives reflect moderate policy strategies with potential for attention-grabbing headlines but require further analysis of their viability in transforming the healthcare landscape.