Less than one week after Senator Majority Leader Mitch McConnell (R-KY) stated that a limited bill could be needed to stabilize the health insurance marketplace, a group of House Democrats from across the political spectrum unveiled a five-part plan to improve upon the Affordable Care Act and stabilize the individual marketplace.
The plan, titled Solutions over Politics, seeks to stabilize the individual market while protecting plans for people with pre-existing conditions, keeping costs down for lower income folks, promoting enrollment and ensuring everyone pays their fair share. The plan also calls for improvements to the ACA including ways to reduce churn in the market and drawing bidding areas to ensure that rural areas aren’t left at a disadvantage.
READ: SOLUTIONS OVER POLITICS: Stabilizing and Improving the Individual Market
Led by the New Democrat Coalition Co-Chairs of the Affordable and Accessible Health Care Task Force, Reps. Kurt Schrader (OR-05), Ami Bera, M.D. (CA-07) and Ann McLane Kuster (NH-02), the group is comprised of members from across the country representing diverse parts of the Democratic Caucus, including members of the House Energy and Commerce and the House Ways and Means Committees, through which the Affordable Care Act was marked up and passed during the 111th Congress.
“It’s time to tackle the real issues. The Affordable Care Act has helped 20 million people access quality health care, many for the first time in their lives,” said Rep. Schrader. “Medicaid expansion has been an unqualified success in red and blue states. But we have to face facts: some folks in the individual marketplace have seen their premiums and deductibles increase significantly due to an imbalance in the marketplace and uncertainty caused by this new administration. Let’s fix that! Our five-point proposal aims squarely at stabilizing and improving the individual market. We’ve talked with health care experts, providers, and patients to find real solutions. If we are serious about making health care affordable for everyone, let’s direct our focus there.”
“We know that the Affordable Care Act has challenges that need to be addressed to expand access to health insurance and bring down costs, but the Republican proposal is not the right answer,” said Rep. Kuster. “Under the GOP’s plan, thousands of people in New Hampshire and millions of Americans, including millions of veterans, could lose access to health care. Today we’re announcing priorities for what I hope will be the first steps toward bringing together Republicans and Democrats behind commonsense proposals to improve the Affordable Care Act for all Americans.”
“As a doctor, health care is about putting the patient’s health first, reducing costs, and increasing the number of people insured – and that’s exactly what these proposals do,” said Rep. Bera. “We’ve made great progress under the Affordable Care Act and it’s time to stop playing politics with people’s lives. I’m urging Democrats and Republicans to work across the aisle and implement these bipartisan ideas that will improve our health care system.”
The group also includes Reps. Peter Welch (VT-At Large), Scott Peters (CA-52), Terri Sewell (AL-07), Kathleen Rice (NY-04), Jim Himes (CT-04), Ron Kind (WI-03), and Suzan DelBene (WA-01).
“Rather than repealing or replacing a landmark law that has expanded quality health care to millions of Americans, the focus of Congress should be on improving the Affordable Care Act,” said Rep. Welch. “We can build bipartisan consensus by taking steps to stabilize the individual market where 7 percent of Americans purchase health plans. Our commonsense reforms will help make health care affordable and accessible to all Americans.”
“Even as we work to defeat the disastrous Republican proposals to repeal the Affordable Care Act, it is clear that Congress will still need to act to improve our current health care system,” said Rep. Peters. “These proposed solutions would help increase choice for Americans who use the exchanges and slow the growth of premiums and deductibles by stabilizing the individual markets. This is what Congress should be doing: putting politics aside and working together to protect what is working in our health care system and fix what isn’t.”
“Health care is a right, not a privilege, and we have a responsibility in Congress to put solutions over politics when it comes to ensuring all Americans have access to quality, affordable health care,” said Rep. Sewell. “I am honored to join my colleagues to urge Republicans to abandon their partisan health care repeal bill and work with us on policies that provide stability and certainty to health insurance markets across the country. Our proposal addresses some of biggest challenges in our health care system with commonsense solutions, like protecting premium assistance, promoting continuous coverage, and protecting essential health benefits. The Affordable Care Act delivered affordable health care to millions of Americans. Rather than going back on that promise, it’s our job in Congress to improve the ACA by reducing costs, increasing coverage, and stabilizing the marketplace.”
“We all know that it’s time for Republicans to stop trying to undermine and repeal the ACA and start working with us to improve the law in a bipartisan way,” said Rep. Rice. “We’re ready to put politics and campaign promises aside and get to work, and we can start with these common-sense proposals to strengthen the individual market and make health care more affordable.”
“In order to continue the hard and necessary work of ensuring that the Affordable Care Act benefits all Americans who need it, we must address the pressing problems of market stabilization,” said New Democrat Coalition Chair Rep. Himes. “Families across the country are struggling with rising costs in every area, especially when it comes to health care. The ideas that we are suggesting today are designed to begin to address these challenges. In recent months, much of our energy has been focused on opposing the destructive efforts to tear down all the good the ACA has done. We will continue that fight, but are also committed to showing the American people that Democrats are not the party of ‘no.’ We have real solutions to real problems.”
“Instead of continuing to push forward a partisan health care bill that will negatively impact the lives of thousands of seniors, veterans, and children, I hope my colleagues will join us in putting solutions over politics,” said Rep. Kind. “It is time we recognize what works in health care, fix what doesn’t, and seek to lower health care costs for all Americans.”
“It’s long past time for Republicans to drop the threat of repeal and start working across the aisle on solutions for the American people,” said Rep. DelBene. “Democrats have always been ready and willing to work across the aisle to build on the progress we’ve made to bring down health care costs and provide stability for individuals and families.”
The plan follows:
Protect Plans for People with Pre-Existing Conditions
What’s Working: The “guaranteed issue” and “community rating” provisions of the ACA ensure patients can’t be denied coverage or charged more based on pre-existing conditions.
What’s the Problem: Many Americans in the individual market have experienced hikes to their premiums and deductibles because some patients have required more health services than their plan predicted. Without a sufficiently funded reinsurance program, insurers will charge higher premiums to make up for, or in anticipation of, financial losses.
What’s our Solution: Create a dedicated annual $15 billion reinsurance fund.
Keep Costs Down for Lower Income Families
What’s Working: The ACA helps millions of families purchase affordable health coverage through cost sharing reduction (CSR) payments. These funds reduce copays and deductibles for lower income families across the country.
What’s the Problem: Uncertainty about funding CSR payments is already creating a crisis in the market, leading to fewer choices for consumers and driving up premiums. These premium increases could cause federal spending to increase by $2.3 billion next year alone.
What’s our Solution: To avoid calamity for millions of Americans, Congress must make it clear that these payments will continue now and into the future.
Promote Enrollment and Ensure People Pay their Fair Share
What’s Working: There’s a correlation between states with more visible marketing strategies around open enrollment periods and the number of people who enroll.
What’s the Problem: We need to ensure people, particularly healthy people, enroll in coverage and stay enrolled. The Administration’s removal of marketing materials in January caused decreased enrollment, and wavering statements around enforcement of the shared responsibility requirement have caused uncertainty among insurers.
What’s our Solution: Robust marketing strategies across the country, particularly during open enrollment periods, would expand the risk pool by bringing younger, healthier adults into the marketplace. We must also continue to enforce the individual shared responsibility requirement of the ACA.
Creating More Affordable Options
Create more options for Americans near Medicare eligibility, including the ability to buy in to Medicare or Medicare Advantage.
Provide additional targeted premium support by age and geography as well as income.
Expand the availability of catastrophic health insurance plans that include essential health benefits and coverage for primary care for younger enrollees.
Ensure that health savings accounts (HSAs) are flexible and compatible with plans compliant with the ACA.
Technical Changes and Improvements
For Enrollment: Consider aligning the ACA’s open enrollment period with tax season.
For Rural America: Ensure rural areas are not at a disadvantage by drawing bidding areas in the individual marketplace to include a balanced pool of enrollees.
For Efficiency: Consider ways to boost and expand use of the Basic Health Program to streamline coverage between Medicaid and the individual private insurance market. Consider allowing ACA subsidy certification for multiple years, which would give people and plans certainty for longer periods.
For Innovation: Spur innovation and bring more choice and competition to the market by issuing clear guidelines and working with states to incorporate smart waiver opportunities that increase choice while maintaining strong consumer protections.
Read the white paper here.