Lawmakers regroup for bipartisan fi x
WASHINGTON — With Republicans unable to scrap Obamacare, several lawmakers huddled last week with a new purpose: fix the law that all agree is flawed.
A group of more than 40 bipartisan House members
has long urged a bipartisan effort, called the planned hearings “another strong step in the right direction.”
With plans for a dramatic overhaul of the 2010 law officially known as the Affordable Care Act set aside for now, consensus seems to be forming around stabilizing marketplaces where individuals without employersponsored health coverage or tax-funded insurance such as Medicaid can buy coverage.
“Even if you disagree with the Affordable Care Act, you don’t want to destabilize markets,” said Loren Anthes, a fellow with the Center for Community Solutions, a nonpartisan think tank based in Cleveland.
The key, he and others say, is maintaining tax-funded payments to insurance companies to reimburse them for waiving deductibles and co-pays to the poorest consumers, as required under Obamacare.
Eliminating the $7 billion in annual payments, as President Donald Trump is threatening to do, likely would cause insurance companies to increase premiums for all consumers to make up for the loss or to leave the market entirely. The Kaiser Family Foundation, a nonprofit that focuses on health issues, projected premiums would jump 19 percent.
If Trump follows through, it would “send shock waves through the insurance market” and shift costs to consumers, warned Andy Slavitt, a former Obama administration health– care official. “They should work together to make the law better.”
Tom Miller, a resident fellow at the conservative American Enterprise
Institute, said Trump’s threats are just that — threats.
“Trump is basically close to saying, ‘you take one more step and I’ll blow up everything,’” he said. “It’s not a valid threat. It’s just a very empty bluff, because what would you do next? You don’t get any political mileage out of making everyone’s life worse.”
Should Trump block the payments, insurers still would be required to offer lower deductibles to low-income patients; they just wouldn’t get paid for it, said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, which is headquartered in Menlo Park, California. To break even, he said, they likely would raise premiums or exit the market altogether. Abandoning the subsidies, he said, “could put enormous pressure on Congress to figure out what to do to stabilize the market in the face of this uncertainty.”
Levitt disputes the common GOP contention that the marketplaces are “imploding,” but he does admit that the markets are fragile, particularly in rural areas. In Ohio, the Department of Insurance announced last week that it had found an insurer for 19 of the 20 counties that had been left without a carrier when Anthem Blue Cross Blue Shield and Premier Health announced they would exit the market in 2018.
“All signs point to (the market) stabilizing in most of the country,” Levitt said.
But, he said, problems remain. Many rural counties have only one insurance company in the exchange, offering limited choice.
And beyond that, insurers
have submitted their initial rates to state regulators for 2018, and in some cases, the increases are steep — in large part because of the uncertainty over what Congress will do.
In Ohio, initial filings with the Department of Insurance from insurance companies show rate increases of 20 percent or higher — assuming federal subsidies stay in place — although state officials reviewing those plans caution that rates likely will change before they are finalized in September.
Kasich and a bipartisan group of governors have recommended that Congress focus on controlling costs and stabilizing the private health-insurance market to ensure access to affordable health care.
“This isn’t a partisan issue,” said Colorado Gov. John Hickenlooper, a Democrat. “We know we need to make improvements, we need to control costs, but we don’t want to roll back coverage or weaken markets.”
Greg Moody, director of Kasich’s Office of Health Transformation, said the administration is encouraged by the bipartisan push to stabilize the health-insurance market.
“It’s an approach that the governor has long advocated, and one consistent with the message from our coalition of Republican and Democratic governors. Ohio has been a leader in health-care reform, and we stand ready to share our experience and expertise with Congress and the administration.”
Anthes, of the Cleveland think tank, said Congress also could seek consensus on
ways to reduce rising costs of health care and prescription drugs if they avoid “getting into the political quagmire of coverage.” Costs also can be reduced with programs to expand preventative care to keep people healthy, care coordination and home-care services that allow people to stay out of expensive institutional care.
Amy Rohling McGee, president of the Health Policy Institute of Ohio, said increases in health-care spending are unsustainable and at some point “we need to get to the real issues of spending and health outcomes.”
“The fundamental problem is health care is too expensive. If we make coverage more affordable, the (individual) mandate becomes less of an issue,” said Dr. Mario Molina, former chief executive of Molina Healthcare. “People want to buy insurance if it’s available and affordable.”
Relatively modest changes are more likely to happen, experts say.
“There is tremendous health-care fatigue in Congress,” Levitt said. “I think it’s hard to imagine a highprofile effort to deal with health care at this point.”
The problem isn’t just disagreements between Democrats and Republicans, Miller, of the American Enterprise Institute, said.
“If you put all the Republicans in a phone booth, they couldn’t agree on what number to call,” he said.