The Trump administration's tacit admission that they'll do nothing to uphold and promote the Affordable Care Act—and the fact that nearly eight in ten voters want Trump and the Republicans to make the law work—is putting tremendous pressure on Congress to do something to prevent the failure of Obamacare insurance markets. They've got a roadmap, if they choose to use it, from a bipartisan group of healthcare experts who are urging them to take action.
“Each of us has been around for a while,” says Gail Wilensky, who served as Medicare administrator under George W. Bush. “We don’t just have centrists but we reflect views across the spectrum.”
“All of us have contacts, networks, and folks we have conversations with on these topics,” says Lanhee Chen, who advised Mitt Romney on health policy during the 2012 campaign. Chen has been supportive of Republican repeal efforts but now has turned his attention to this plan to fix the law. “The unique element of this group is the breadth and depth of contacts in policymaking circles.”
“This package is no one’s conception of what is perfect health reform,” says Ron Pollack, chair emeritus of the health advocacy group Families USA, an ardent defender of the ACA. “None of the signatories, if acting alone, would offer this precise package. But that is the whole process of bipartisanship. As a composite, we think this is constructive and has the best opportunity to move forward in Congress.”
Their plan is not rocket science and it's not a transformation of the healthcare system—it's an approach to stabilizing individual insurance markets as they exist under Obamacare and preventing further disruption. There are four components:
- Authorizing the cost-sharing reduction payments to insurers Trump has been holding hostage. "If Congress were to appropriate this funding, as this plan recommends, it would make that lawsuit moot—and bring a lot more certainty to the payments insurance plans on the individual market can expect to receive."
- Continuing outreach efforts to get new, qualified customers to sign up. “A compromise should involve combining incentives to purchase health insurance with effective sanctions for not enrolling or not maintaining coverage, including financial penalties and waiting periods,” they recommend.
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Allowing more state innovation to “combine private and public coverage to provide greater freedom and work opportunities for disabled Americans.” That's a sticky one, as it could impinge on Medicaid coverage and the essential health benefits required by the law, but the group does stress that they don't want the "guardrails" of those protections removed, but "refined."
- Allowing expansion of Health Savings Accounts, which is just a sop to conservatives. HSAs are essentially glorified tax shelters, used primarily by people with high enough incomes to actually have enough left over every month to be worth saving and to need some place to stash their dough tax free. But in and of themselves, HSAs aren't going to undermine the law. They're just no substitute for the financial assistance that Obamacare has provided.
- Fully funding the Children’s Health Insurance Program (CHIP), which will expire at the end of next month without congressional action. CHIP covers about 8 million children. It's not part of Obamacare, but is critical to the larger safety net system for health care, and helps stabilize the markets.
Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) the leaders of the health committee that is working an Obamacare stabilization effort will likely be responsive to this effort precisely because of who is behind it—all the previous healthcare leaders from both parties. Again, this isn't a reform movement. This is a rescue mission, attempting to prevent Trump from wreaking disaster on millions of lives.