TIME RIGHT TO FIX OBAMACARE

For once, we have to agree with President Donald Trump: It is not yet time for Congress to move on from health care.

Granted, we have something a bit different in mind about what the legislative branch should do next. While Trump is fixated on pushing the repeal-and-replace rock up the hill again and again, we are encouraged by an emerging effort in Congress to find bi-partisan solutions to shore up the existing system — and, not incidentally, prevent the Trump administration from making its predictions about the Obamacare death spiral a self-fulfilling prophecy.

On Sunday, Politico reported the House Problem Solvers Caucus, a group of moderate Democrats and Republicans, is working with other centrists on a package of reforms to stabilize the state insurance exchanges.

Perhaps the most important item is a guarantee the fgovernment will continue making cost-sharing subsidy payments to insurers. That’s a mechanism of the ACA designed to compensate insurance companies for costs associated with the law’s requirement that low-income consumers be spared excessive out-of-pocket expenses for co-pays, deductibles and co-insurance. It’s worth about $7 billion a year to the insurers.

Another big one is the creation of a nation-wide system of reinsurance, a mechanism that helps deal with a phenomenon called “adverse selection.” Because the Affordable Care Act prevents insurance companies from denying people coverage because of pre-existing conditions or from charging them more when they become sick, the insurance pool in most places has skewed toward those with high medical expenses. Reinsurance programs provide subsidies to insurers to help cover some of those expensive patients, thereby reducing the pressure to increase premiums on everyone else.

The three other elements of the plan scratch some Republican itches without gutting the ACA as a whole. One would repeal a tax on medical devices, which generates relatively little revenue (about $20 billion over 10 years) but has led to a massive lobbying effort from manufacturers and has been a target of some Democrats’ ire as well. Getting rid of that tax was part of the “skinny repeal” plan that died in the Senate last week. 

Another would require businesses to provide coverage only if they have more than 500 workers, up from the current 50. This, too, would have relatively little impact, since the vast majority of businesses with 50 employees provided employee health plans before Obamacare anyway. Finally, the proposal includes mechanisms to facilitate the sale of health insurance across state lines. Democrats have long objected to the idea on the grounds it could lead to a race to the bottom in which insurers flock to states that allow them to sell low-premium policies that offer little value.

On the whole, the Problem Solvers plan would in fact solve problems. But there’s a big one Congress can’t easily address, which is the possibility Trump will stop enforcing the requirement that individuals buy insurance. When asked about it on ABC’s “This Week,” Health Secretary Tom Price claimed the mandate was “driving up the cost for the American people in terms of coverage” and indicated his agency might stop enforcing it.

Even hinting that the administration doesn’t take the mandate seriously could have a hugely detrimental effect on the insurance exchanges because a key driver of cost increases is the number of younger, healthier people who choose to pay a fine rather than buy coverage.

The courts would be the only real recourse for ACA supporters if Trump decides to flout his responsibility to enforce the law.

But Congress can act now to stave off some of the other chaos the president is trying to sow. Insurance regulators are grappling with setting premiums for next year. There’s no time to lose.

— The Baltimore Sun

CREDIT: THE BALTIMORE SUN