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As presidential candidates begin to make more public appearances and engage in policy debates, healthcare is once again a hot topic. Both the Affordable Care Act (ACA) and attempts replace it are being criticized from highly politicized points-of-view. While the extreme ends of the political spectrum propose vastly opposing solutions for strengthening healthcare, as with most issues, what most Montanans and Americans would prefer lies somewhere in the middle.

There are obviously distinct differences between Democrats and Republicans on this topic. Some progressives are calling for an upheaval of the ACA and a move toward a more government-controlled insurance system — whether it is single-payer, Medicare-for-all or buy-in, or a public option. Meanwhile, Republicans have long used the rallying cry of “repeal and replace” to call for yet another upheaval and reconfiguring of our entire healthcare system.

Neither of these options seems palatable or practical. If nothing else, congressional Republicans have proved that simply repealing and replacing the ACA is a far more challenging task than it sounds. Doing so would also likely jeopardize the current access to health care insurance millions of Americans enjoy. Yet calls for a more government-controlled healthcare system are misguided as well. A public option is simply the long road to Medicare-for-all, as a few of the Democratic presidential candidates have already conceded. Either way, market-based plans and employer-sponsored coverage could struggle to compete under such a system, which could result in higher private plan premiums as well as diminished quality of care, fewer options and longer wait times for patients.

Both Republicans and Democrats want to make changes in the economics of healthcare while encouraging access, increasing quality, and continuing the American tradition of medical innovation. But making these changes will be complicated and neither a quick leap to single-payer nor repeal and replacement of the ACA is the panacea.

U.S. Sen. Jon Tester’s approach of making gradual improvements to our system while preserving core ACA principles — like coverage for pre-existing conditions, access to preventive care, and transformation in healthcare delivery — is far more conducive to fostering lasting, long-term change. We need to focus on ways in which we can build upon what successes we have seen under the ACA while addressing the issues that persist. That is how to improve health care for all Americans.

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Rep. Kathy Kelker, D-Billings, represents House District 47 in the Montana Legislature. 

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