Five bipartisan steps to save health care | Editorial

It’s getting to be crunch time for the 2018 “Obamacare” health insurance exchanges. The Trump administration and Republican-controlled House and Senate have not come to terms on either repealing “Obamacare” or offering alternative fixes that could impact health-care coverage for those covered by the health insurance exchanges starting Jan. 1, 2018.

“Obamacare” open enrollment starts Nov. 1 and ends Dec. 15.

This has created a lot of uncertainty in the health insurance market, resulting in premium increases of over 25 percent through the health insurance exchanges.

Fortunately, some headway was made last week when Senate Finance Committee Chairman Orrin Hatch, R-Utah, and Sen. Ron Wyden, D-Ore., announced they had reached an agreement to prevent the planned elimination of federal funding for the Children’s Health Insurance Program (CHIP). The current appropriation for the program runs out at the end of the current fiscal year — Sept. 30.

The Senate plan would provide “uninterrupted funding for CHIP” and “increased flexibility for states to administer the plan” for the next five years, according to Hatch.

Nearly 9 million children receive health insurance through the CHIP program, costing the federal government more than $14 billion a year. The program is for children in families who make too much to qualify for Medicaid. The CHIP program also provides higher levels of health care than these children would receive through “Obamacare.”

Now, President Donald Trump is pushing GOP leadership to make one more last effort to repeal “Obamacare.”

As a result, all the ensuing uncertainty has created concern in the health insurance marketplace, resulting in even higher premiums, with increases approaching 25 percent in markets, such as West Virginia, without competition.

However, according to the Bipartisan Policy Center and its Future of Healthcare Initiative, two of its senior policy experts — Bill Frist, former Senate Republican majority leader from Tennessee, and Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services — have formulated “Five Bipartisan Steps to Save Healthcare.”

Their message is simple: Put partisanship aside and end federal uncertainty about support for the Affordable Care Act. Otherwise, premiums will end up being higher than necessary while more insurers will withdraw from markets across the country.

With only weeks before the “Obamacare” health insurance exchanges open for business again, Washington has one more chance to take clear action to bring down premiums and help millions of American families.

Frist and Slavitt developed five recommendations that could stabilize the individual health insurance market:

First — and most important — Congress should act to cut average premiums by 20 percent nationally. Lawmakers should commit to funding cost-sharing reduction subsidies for insurance companies in the ACA exchanges for 2018 and 2019. These payments reduce the size of deductibles for low-income people and are already accounted for in the federal budget.

Second, Congress should establish a targeted fund for states to use to reduce premiums. The cost of insurance for all of us can be affected by even a small number of expensive patients with complex medical conditions. Innovative efforts, as have been seen in Alaska, demonstrate that this approach works.

Third, the federal government should cut its review time for approving state innovation applications in half, to a 90-day maximum. The ACA has provided states the opportunity to waive various provisions of the law with local innovations, as long as important consumer protections are kept in place. Only two such innovations have been approved so far, but many more states have submitted applications. Done right, these innovations can improve competition and choice and reduce premiums while maintaining important protections.

Fourth, Congress should help middle-income consumers manage the size of their deductibles. It can do this by allowing consumers to temporarily increase the amount of money they can set aside for pretax health saving account contributions for 2018 and 2019 to equal the out-of-pocket limits for high-quality health plans.

Finally, the federal government should develop alternatives that allow states, beginning in 2020, to potentially replace the ACA’s mandate that most individuals buy coverage or face a penalty. The individual mandate plays an important role in keeping premiums low, but is also unpopular with the American public. So even while this mandate is enforced, Congress should direct the administration to explore an option similar to one used in Medicare — automatically enrolling consumers in low-cost coverage and providing incentives to enroll on time.

The question remains whether Congress can actually work in a bipartisan fashion on behalf of the American people. The cost of health care has gotten out of control, with many Americans on high-deductible plans unable to utilize their health plans due to overall costs.

But if Republicans and Democrats can work together in the days and weeks ahead, then Congress and the Trump administration have the opportunity to bring down the cost of insurance premiums, reduce high deductibles and make a positive impact in the lives of many Americans, especially those in the middle-class.

But it takes some give and take from both sides of the political aisle.


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