Guest opinion: Make Obamacare work again
Shortly after withdrawing an unpopular bill that would have put the health coverage of 24 million Americans in jeopardy, Speaker of the House Paul Ryan declared that “Obamacare is the law of the land … for the foreseeable future.”
Though proponents of the Affordable Care Act celebrated the defeat of Ryan’s ill-conceived American Health Care Act, clearly there’s work to be done with the ACA – the comprehensive health care reform package that Republicans and President Trump vowed to repeal and replace. For his part, President Trump said “the best thing we can do, politically speaking, is let Obamacare explode.” Meanwhile, it’s been reported that conservative House members and the Trump administration are discussing new ways to repeal and replace the law.
The ACA will certainly struggle if federal lawmakers and the Trump administration continue to hamper the operation of the act, but there also certainly are steps the administration can take to make that prospect less likely.
Support cost-sharing reductions: In 2014, Congress filed a lawsuit challenging Obama administration payments to insurers to support cost sharing reductions (CSR) that were created by the ACA. The plaintiffs argued that the funds to support the program were never appropriated by Congress. CSR helps make insurance more affordable by reducing out-of-pocket costs for those earning under 250 percent of the Federal Poverty Level who receive an ACA premium subsidy through a health insurance exchange.
Without a congressional appropriation, insurers would be responsible for bearing the cost of CSR, a total estimated expense to insurers participating in exchanges of $130 billion over 10 years. If required to bear this burden, insurers likely would either stop participating in exchanges or raise health insurance premiums to cover their costs.
The judge in the CSR lawsuit ruled in favor of Congress, but allowed CSR payments to insurers to continue pending the outcome of an appeal. Some beneficiaries of CSR have filed a motion to intervene in the suit so that they can defend the payment structure in the event the Trump administration does not. The bottom line: While senior congressional Republicans announced their intention to fund CSR in 2017, if the plaintiffs lose this suit, Congress will likely take action to eliminate CSR altogether, harming millions of lower-income enrollees.
Enforce the individual mandate: The first executive order signed by President Trump included broad language ordering federal agencies to “ease the regulatory burdens” of the ACA. There have been questions since regarding what this means, but what is clear is that the IRS is relaxing enforcement of the individual mandate. The mandate is an essential component of the ACA, and while the penalties have been criticized as being too low to bring people in to the insurance market, relaxing their enforcement is likely to undermine participation in insurance. If the mandate isn’t enforced, sicker people will still participate in the insurance market because they need care, but younger, healthier people will be even more likely to stay out of the market. This dynamic drives up premiums and is unsustainable over time.
Don’t undermine the market through regulatory action: The Trump administration already issued its first set of ACA proposed regulatory changes after meetings with the nation’s insurance companies. Among other things, the proposed changes would shorten the open-enrollment period to six weeks and make it harder for people to qualify for special enrollment periods. A shortened open enrollment period may pose particular problems in Colorado where IT and customer service infrastructure may not be able to keep up with significantly increased workloads occasioned by a compressed time frame. In addition, requiring everyone claiming eligibility for a special enrollment period to prove (rather than certify) their eligibility will make it more difficult for people to enroll. We should make it easier, not harder, for people to get insurance.
Fix the “family glitch”: The so-called family glitch prevents family members of people with employer-sponsored health insurance from being eligible for premium assistance for individual coverage on the exchanges. Fixing the glitch would bring more people into coverage and increase the number of young and healthy people in Connect for Health Colorado and other exchanges.
Every major piece of legislation needs work after passage. The ACA has helped millions of Americans gain insurance coverage, lowered prescription drugs costs for seniors, supported improvements and reforms in health care delivery and payment systems, and ensured that health insurers don’t rescind coverage when people get sick. Rather than ensuring it fails, Congress and the president should help the “law of the land” succeed.
Elisabeth Arenales is the Health Program Director for Colorado Center on Law and Policy, a nonprofit, non-partisan research and advocacy organization that engages in legislative, administrative and legal advocacy on behalf of low-income Coloradans.