Furthermore, the ACA exchange policies are very poorly designed for a pandemic. For many people who are normally reasonably healthy, they are meant to be merely catastrophic insurance. The most common plans tend to have very high cost-sharing compared to employer insurance (in-network, out-of-pocket costs are capped at $8,150 for individuals and $16,300 for families) and very narrow networks. Many exchange plans have even higher caps or no cap at all on out-of-network costs. That is the last thing you want in a pandemic, where in an emergency, you will be sent to whichever hospital has open beds, regardless of your network status.

For many who lose their jobs right now, their exchange options will effectively be financial Russian roulette, with plans designed to discourage them from getting treatment. Individuals who lose their jobs could face both serious illness and crippling costs due to high out-of-pocket limits and/or surprise billing. Fixing the flaws of the ACA would require multiple massive changes, since high cost-sharing to discourage people from getting too much care is at the core of the entire design.

Creating a New Plan Would Take Too Long

Something like Sen. Bernie Sanders’s Medicare for All likely couldn’t be set up in time. Any new system would require months, if not years, to work out the specific new rules and regulations. The same issue exists for ideas like a “coronavirus crisis insurance program” based on Medicare to cover those with the virus. Meanwhile, a narrow program would do little for those who lost their jobs due to Covid-19 quarantine measures. The same goes for those suffering because treatment for conditions that would have been relatively cheap to treat were delayed, or those who depend on hydroxychloroquine but can’t get their prescription filled due to the crisis. And what about people who were treated for Covid-19, but it turns out they merely had regular pneumonia? You want a program that is fully formed — and all you need to do is change one line of a bill to add millions of people to it.

Of the Existing Government Insurance Programs, Tricare Is the Best Choice

Dramatically expanding Medicaid to cover more people would be a good option but is legally not viable. Thanks to the Supreme Court case National Federation of Independent Business v. Sebelius, the federal government can’t force states to expand Medicaid, which is why 14 red states still haven’t taken part in the ACA’s Medicaid expansion.

Existing Medicare is both not really designed for younger people and has some needless complexity that makes quick expansion in a pandemic a problem. Medicare doesn’t have an out-of-pocket cap, something you want during this pandemic. The gap is normally addressed with seniors buying Medigap coverage or choosing a Medicare Advantage plan. All new rules would be needed for providing these for younger people. Traditional Medicare also doesn’t cover drugs, requiring people to select a Medicare Part D plan.

This is why Tricare, particularly Tricare Select, makes the most sense. Tricare currently covers 9.4 million Americans and could relatively easily be scaled up by just changing a few lines of legislation about who qualifies. Tricare Select is the PPO military insurance plan designed for people under 65 who aren’t in the military. It’s the broad network plan for military family members and those retired from the military. It offers full coverage, including drugs. Its provider reimbursement rates are already based off Medicare. It also has very modest cost sharing, which would make sure that people who think they might need care seek it out, exactly what you want from a public health perspective when confronting a highly contagious disease. Co-pays are small: the deductible is only $156 for an individual, with a much more reasonable catastrophic cap plus existing rules that prevent large surprise bills from unscrupulous hospitals and physician companies trying to take advantage of this crisis. It is exactly the kind of insurance we want people to have during this crisis, and, most importantly, it already exists.

We Need an Anti-Bailout Position Ready to Go

The reality of the pandemic, the economic conditions, and the political climate is changing on a daily basis. Ideas that were unthinkable a few weeks ago now have majority support. Private insurers are also asking for their own indirect bailout by infusing them with more money. If things get worse, expect them and every other industry to come back again for another round. We can’t have a solution that makes companies whole but leaves people with thousands of dollars of medical debt just because they were “covered” by high-deductible exchange plans. Or one that only directly pays for Covid-19 treatment but is full of holes, leaving people with huge bills because they went in for treatment but ultimately just had the flu. Or one that does nothing for the millions of people who merely lost their job and their quality coverage due to necessary quarantine measures. Or does nothing for the people who will suffer longterm health consequences even after surviving the virus.

The alternative out there needs to be comprehensive, and most importantly, ready to be immediately deployed. We need a solution that can be used even faster than any industry bailout or targeted reinsurance program that has the government take on the insurers’ cost for covering Covid-19 patients. The best answer is a massive expansion of Tricare Select. Expand it to all the people who have lost coverage due to the pandemic, all those “contractors” providing critical delivery right now, everyone keeping our supply chains moving, to everyone who needs it, to as many people as possible. You can even rename it to whatever self-flattering name gets a president to sign it.