As Democrats look for a viable healthcare message ahead of the midterm elections, one well-connected think tank is pushing the party to embrace a new idea: free primary care for all Americans.<\/p>\n
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Searchlight Institute senior fellow David Bowen, a former Senate aide who helped craft the Affordable Care Act, said it would be delivered either through that law\u2019s marketplaces, expanding on the preventive services mandate, or through a new \u201cpublic option\u201d that the group is calling the \u201cAmerican Health Gateway.\u201d<\/p>\n
\u201cWe know very, very well that getting people better primary care is a conduit to better overall health,\u201d said Bowen, who led the policy report, <\/a>which was first shared with NBC News. \u201cIt\u2019s conduit to savings, and we want to make sure that people are not dissuaded by cost from doing that. We also provide a new way of expanding people\u2019s coverage to recognize the reality of families today.\u201d<\/p>\n The proposal comes as millions of Americans have lost access to health insurance or seen their coverage downgraded after Republicans allowed enhanced ACA subsidies to expire<\/a> at the end of last year.<\/p>\n The ACA\u2019s preventive services mandate requires most insurers to cover things like vaccinations and cancer screenings without charging a copay or deductible. Searchlight\u2019s primary care proposal takes that much further: If a person shows up at the doctor and has an ear infection, for instance, the evaluation and prescription for that would be cost-free.<\/p>\n \u201cIf you get basic primary care, sort of in a variety of settings, this too would be free at the point of service. So it\u2019s an expansion of that policy,\u201d said Bowen. \u201cIt\u2019s not, obviously, free care for everything, but it is a significant chunk of additional services that are going to make a difference in people\u2019s lives.\u201d<\/p>\n Free primary care wouldn\u2019t cover things like surgery, hospital stays, cancer treatment or most specialized care.<\/p>\n Still, Art Caplan, the head of the medical ethics division at NYU Grossman School of Medicine in New York City, who was not involved in the report, said \u201cprimary care is probably the most crucial domain of healthcare.\u201d<\/p>\n \u201cIt\u2019s for everyone, from newborns to all the way up to those age 100,\u201d he said. \u201cIt helps you stay healthy. It helps you maintain and deal with chronic issues.\u201d<\/p>\n Behind the push by the new group, launched last year by former Democratic operatives and policy wonks, is a belief that their party is stuck in a rut on healthcare, with a decadelong divide between those who want \u201cMedicare for All\u201d and others who want to preserve the current system, perhaps with a \u201cpublic option\u201d (a federal health insurance plan to compete with private insurers).<\/p>\n Adam Jentleson, the president and founder of Searchlight Institute and a former longtime Senate aide, said Democrats must offer fresh ideas and cannot afford to coast on past health policy successes or simply oppose Republican proposals.<\/p>\n \u201cThis is still our best issue, but we have not been on offense in a way that\u2019s capturing people\u2019s imaginations and getting them excited,\u201d Jentleson said. \u201cWe don\u2019t need to be on defense or just advocating for incremental reforms.\u201d<\/p>\n \u201cAnd we think we can bring something new to that conversation,\u201d he said. \u201cWe hope it will be useful to candidates in 2026 but will hopefully build toward something bigger in 2028.\u201d<\/p>\n The group plans to distribute a polling memo<\/a> to congressional Democrats and leadership offices that undergirds the case for its proposal. A survey<\/a> the group commissioned found that voters tend to like their own health coverage but are dissatisfied with the insurance system as a whole.<\/p>\n Larry Levitt, executive vice president for health policy at KFF, a nonpartisan research group, said free primary care is a more realistic path than Medicare for All, since people could keep their existing insurance and private plans would still exist. Many people, he added, are already exempt from deductibles for primary care visits, though they often pay a copay.<\/p>\n As the group didn\u2019t detail how the program should be funded, Levitt wondered whether the cost would fall on insurers, taxpayers or some combination of the two.<\/p>\n \u201cThe money to pay for it has to come from somewhere,\u201d he said. \u201cAnd it would likely mean a modest increase in premiums that would be paid for by employers and employees.\u201d<\/p>\n It would also need to address E&M codes, the billing system providers use to get paid for office visits and other care.<\/p>\n \u201cAnd how would it work for people who didn\u2019t have insurance at all?\u201d Levitt asked.<\/p>\n Caplan said the U.S. would also need to address a shortage of primary care doctors.<\/p>\n \u201cA lot of people still won\u2019t have access because there\u2019s not a family doctor or a primary care provider in their area,\u201d he said.<\/p>\n Searchlight, which launched last year and is named after former Senate Democratic leader Harry Reid\u2019s hometown, is seeking to establish a foothold in the Democratic policymaking debate. It is criticizing a recent health policy blueprint<\/a> by the influential Center for American Progress, a Washington-based think tank with deep ties to the last three Democratic administrations. (Jentleson used to work at CAP.)<\/p>\n \u201cIf you see the Center for American Progress, their big healthcare release for the entire year is like two pages on price negotiations,\u201d said Ahmad Ali, Searchlight\u2019s communications director and a former aide to House Democratic leadership. \u201cI mean, this is very small thinking, and we have more to do to actually go out there and start changing minds.\u201d<\/p>\n