While Congress is on recess after failed attempts to repeal the Affordable Care Act, commonly known as Obamacare, a bipartisan group of governors has come forward with its own solution to fix the health-care system.
Written by Govs. John Kasich (R-Ohio) and John Hickenlooper (D-Colo.) with six other governors signing on, the plan makes adjustments to the ACA around the edges, as opposed to the large upheavals that Republican lawmakers have been trying to move through Congress. The governors’ recommendations attempt to stabilize the market, lower premiums and encourage more state-level innovation.
Make health care more affordable
Problem Few young and healthy people are in the market, making insurance premiums more expensive for everyone in the marketplace.
Solution Keep the individual mandate in place.
Solution Fund outreach to encourage young people to enter the market.
Solution Do more comprehensive verification for people who want to enroll outside of the open enrollment period, preventing people from just getting insurance when they’re sick.
Problem Overall health-care costs are rising rapidly.
Solution Pay for care based on the quality (measured via hospital readmission rates, among other things), not the quantity, of health-care services provided.
Solution Give consumers tools that allow them to compare the cost of different providers.
Problem Many families don’t qualify for subsidies because their employer option is considered adequately affordable. But that calculation is based on what an individual, not a family of the same income, can afford.
Solution Make the affordability calculation for families based on affordability for a family, not individuals.
Increase stability in the marketplace
Problem Some counties may end up with no insurer offering coverage in their marketplace.
Solution Exempt insurers who are the only ones left in the market from a health insurance tax.
Problem Insurers are facing uncertainty over whether the administration will continue paying subsidies that help low-income people afford their deductibles and co-pays. That has caused premiums to become more expensive and some insurers to leave the marketplace altogether.
Solution Enact a law that funds the subsidies through 2019.
Problem Since insurers are required to offer everyone coverage, they sometimes get extremely expensive customers, making their costs higher and the marketplace less stable.
Solution Create a stability fund that helps the insurers pay for their most expensive patients.
Give some power back to the states
Problem States aren’t given enough room to innovate under the ACA regulations.
Solution The federal government should stop making regulations that encroach on the states’ regulatory powers that were affirmed by the ACA.
Solution Streamline the waiver process, which allows states, in some circumstances, to exempt themselves from ACA regulations and innovate new health care insurance models.
Solution Let states build off the “innovation waiver” plans that have already been approved in other states.
Problem Some insurers face very high costs because of what the ACA requires them to cover.
Solution Allow states to change the “essential health benefits” every insurer is required to offer. Since this would happen through the state innovation waiver program, though, the plan must insure at least as many people as cheaply and as comprehensively as the status quo.
The next stop for the proposal comes on Sept. 7, when a handful governors — including Hickenlooper, who cowrote this plan — will meet with Congress to discuss bipartisan fixes to the ACA.
The six other governors who signed onto the proposal were Democrats John Bel Edwards (La.), Steve Bullock (Mont.), Terry McAuliffe (Va.) and Tom Wolf (Pa.); Republican Brian Sandoval (Nev.); and independent Bill Walker (Alaska). Each of their states, except Virginia, expanded Medicaid under the ACA.