EDITORIAL: Ideal time for a deal to repair and keep the Affordable Care Act

Akron Beacon Journal (OH)

April 20--President Trump could wreck the Affordable Care Act with one blow. He could halt the flow of federal money into what are "cost-sharing reductions." These payments help 7 million lower-income people who purchase their health insurance through the marketplace exchanges. The funds reduce co-payments, deductibles and other costs, making coverage more affordable.

Without such assistance, many people would exit the exchanges. Insurers would leave, too, the market becoming less stable, even verging on what the president has predicted, "imploding," "exploding right now," leading to a "very bad year."

For now, insurers are watching carefully to see what the president does. They met with White House officials this week. The payments are the focus of a lawsuit, Republicans challenging the concept and prevailing initially in court. The president has continued with the payments.

Will that position hold?

Insurers are struggling with the uncertainty. This is the time when they make decisions for the following year about participating in the exchanges. So, even no decision by the president would be harmful. Already the president has ordered agencies to begin dismantling the act "to the maximum permitted by law." He pulled back on television advertising at the end of the enrollment period (late January), and fewer people signed up.

One cautionary note since then is the collapse of Republican efforts to repeal and replace the act. Bring down the Affordable Care Act, or at least the exchanges for those buying coverage on their own, and there still would be no credible alternative.

The Trump White House and its Republican allies would have the explaining to do.

Ideally, this would be a moment for presidential reflection, or remaking gut instincts. Congressional Democrats have been seeking to leverage an imminent government spending bill, necessary to keep agencies and offices in operation, to preserve the payments. Here is another opportunity to pursue a compromise, sustaining the act while making repairs favored by Democrats and Republicans.

Analysts have identified many areas ripe for deal-making. For instance, both sides recognize the problems stirred by the requirement that larger employers provide health coverage to workers employed 30 hours or more per week. Republicans also want to remove the excise tax on high-cost plans and make the benefit part of personal taxable income. Democrats hardly should quarrel.

Both parties rightly have criticized high deductibles, joined by skimpy coverage. Then, work to make the subsidies more realistic. Way back, Republicans introduced the concept of the individual mandate. Strengthen its use while designing coverage options that generate more interest among the younger and healthier.

As the Congressional Budget Office and other analysts have pointed out, the health exchanges have been solid enough, even improving the past year. What they require are reinforcing measures, adjustments mirroring lessons learned, or what House Republicans did not provide in their failed attempt at repeal and replace.

Better to focus now on serious repair, starting with a commitment to sustain the "cost-sharing reductions." That would encourage insurers to push ahead into next year, health coverage continuing for millions of Americans. The Trump White House has an opening to show that Washington can get difficult things done.

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