A major problem with the Affordable Care Act is the way it was passed: on a party-line vote, without support from a single Republican. This made the law vulnerable and created uncertainty about its future among market participants. The unsuccessful GOP repeal-and-replace efforts have been just as divisive. For a policy change of this magnitude to be lasting and stable, it should have at least some bipartisan support.

Universal coverage should be pursued in a way that is affordable, both to households and to the government, and that helps lower the trajectory of health-care costs overall. It should lead to higher-quality medical care, to make being insured attractive to households, and should encourage innovation, productivity and technological progress in the health-care sector. It should encourage young and healthy people to be covered in order to balance the risk pool facing insurers, making it attractive for insurers to offer insurance. It should ensure that even the hard-to-cover are insured.

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