Breaking ACA gridlock
For seven years, congressional Republicans and Democrats battling over Obamacare have agreed on only one thing: They couldn’t agree on anything.
As more Americans dropped or skipped coverage because of soaring premiums, lawmakers of the two parties couldn’t— wouldn’t—agree on how to fix the 2010 law.
As insurers narrowed networks of doctors and hospitals or abandoned states entirely, Congress flailed.
Then last Thursday President Donald Trump vowed to yank billions in subsidies to insurers that help cover medical costs for millions of working-class households.
And lawmakers—here’s a shock—did something about it. Five days after Trump’s declaration— blink of an eye in Congress- time— Republican Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington announced that they’ve reached a tentative deal to stabilize Obamacare for two more years.
Under the deal, those subsidies Trump planned to cut would be restored. That would help many lower-income Americans who earn too much to be eligible for Medicaid. That’s a win for Democrats.
The other major prong of the deal would help younger, healthier people who say they don’t want, or can’t afford, the comprehensive and expensive insurance that Obamacare mandates. More Americans would be able to buy low-cost catastrophic coverage. Score a win for Republicans.
Now, cue the usual naysayers— Republicans and Democrats on the wings of the parties who brook no compromise.
The Republican hardline conservatives complain that this deal isn’t the complete repeal-and-replacement that they promised voters. They won’t be satisfied until Obamacare is rubble.
Their Democratic counterparts on the far left grumble that catastrophic coverage isn’t enough for most Americans and will leave some dangerously undercovered in event of a health crisis. They won’t be satisfied until a single-payer system—national health care for all, controlled and funded by the federal government (that’s you, taxpayers!)—rules the land.
But we like the outlines of the Alexander-Murray deal: It helps two huge groups of Americans.
We’ve argued against pulling the subsidies and undermining already shaky markets before Congress passes a better replacement for dwindling Obamacare. Remember, a federal district judge ruled last year that these subsidies are illegal because Congress never appropriated money for them. The Obama administration gave itself permission to fund them. Congress now can settle the issue by funding the subsidies, as this proposal would.
We’ve also urged lawmakers to give insurers flexibility to offer more choices to customers, not just the rigid gold-silverplans of Obamacare. That’s a direct pitch to the younger, healthier people who think they don’t need or can’t afford coverage—and who have refused to obtain it. Guess what? They do need coverage for the costly emergencies they can’t anticipate. And insurers should be able to provide the low-cost alternatives Obamacare has largely forbidden.
Americans can start choosing health plans from government exchanges on Nov. 1. From the get-go, Obamacare enrollment has never met lofty government forecasts. Now the forecast is gloomier because of rising premiums and cutbacks in advertising and outreach, the Congressional Budget Office says. The average monthly enrollment on the Obamacare exchanges is expected to be about 11 million Americans in 2018. That is down about 7 million from the agency’s 2016 forecast for 2018, a CBO spokesman tells us.
As these millions of Americans walk away from its rigidity, Obamacare desperately needs infusions of flexibility and competition. The Alexander-Murray proposal would buy time for that to happen. We hope the two senators can persuade enough colleagues to climb down from their rigid all-or-nothing perches. Millions of people need affordable coverage now.