An unlikely coalition of liberal and conservative health-policy leaders is calling on Congress to strengthen the existing health-care law in a variety of ways to help Americans get and keep insurance. In particular, the group is urging the government to continue paying all the federal subsidies provided under the Affordable Care Act and to help Americans enroll in coverage.
In a five-point set of principles issued this week, the coalition laid out a potential bipartisan path forward after a Republican strategy to tilt federal health policies in more conservative directions failed in the Senate last month. The group’s effort comes as the latest polling provides more evidence that most Americans want lawmakers from both parties to work together to fix the 2010 health-care law.
Beyond encouraging Congress to preserve the cost-sharing subsidies to insurers that help 7 million lower-income customers in the ACA marketplaces, the coalition says that states should be allowed latitude to merge the funding of health insurance programs for people who are poor.
It also says the government must continue strong incentives for Americans to carry health insurance — either through the ACA’s unpopular individual mandate or other methods. The goal is to promote both individual responsibility and stable insurance pools with enough healthy customers to balance out the cost of covering people who need expensive care. And it says the government must quickly bring health plans to about two dozen counties that now lack any insurer willing to participate in the ACA marketplaces for 2018.
The four-page consensus document by the Health Reform Roundtable is the product of eight months of discussions among an ideologically eclectic group of nine health-care experts based at think tanks, universities and advocacy groups — some of whom have held senior policy roles in the federal government or presidential campaigns.
During a call with reporters, the group’s members said their agreement is not complete. But the areas of common ground make clear the extent to which President Trump’s views on the government’s role in health care deviate from those of respected voices on both the left and the right.
Trump has derided the ACA, making statements that insurers and others say are destabilizing the insurance marketplaces created under the law for people who cannot get affordable coverage through a job. Most vividly in recent weeks, the president repeatedly has threatened to end the cost-sharing subsidies — currently about $7 billion — paid to marketplace insurers to help lower-income Americans afford their health plans’ premiums and other out-of-pocket charges.
In addition, the Health and Human Services Department has sent out weekly maps of counties lacking marketplace health plans for the coming year. They are issued as evidence of the law’s failures without suggestions for how to improve access to coverage.
One possible way of covering those bare counties, the coalition suggests, is to require any insurer that wants to sell health policies to federal employees in such counties to also offer at least one health plan in the ACA marketplace.
In addition, the coalition urges the government to continue its activities to help coach consumers on how to enroll in coverage. In late January, administration officials canceled some advertising and other outreach activities in the final days of the last enrollment period, and they have not said how they will approach the next period, beginning Nov. 1.
The group’s document says that Congress should renew the funding for the Children’s Health Insurance Program, a 20-year-old type of government insurance for children of the working poor with incomes slightly too high for Medicaid. CHIP’s funding is scheduled to run out at the end of next month, unless Congress renews it. The budget proposed by the White House in the spring did not include money anticipating that renewal, and the president has not spoken about his intentions.
In releasing the common-ground statement, the coalition’s founders, Gail Wilensky, a Republican who is a senior fellow at Project Hope, and Ron Pollack, chairman emeritus of the liberal consumer-health lobby Families USA, said they began talking at a time when it appeared that the GOP-controlled Congress would pass a repeal of the ACA without spelling out what would come afterward.
With the Republican attempt to refashion the health-care law having stalled, “we are trying to model bipartisanship so incremental steps can be taken,” Pollack said. He and other coalition members said they intend to present their consensus idea as a blueprint to lawmakers, including Sens. Lamar Alexander (R-Tenn.) and Patty Murray (Wash.), the chairman and top Democrat of the Senate Health Committee. The panel is planning a bipartisan hearing on health care next month.
Such efforts are in sync with public opinion, according to findings released Friday morning from the most recent monthly survey on health-care attitudes by the Kaiser Family Foundation. It was conducted the week after last month’s collapse of the Senate GOP’s efforts to end key elements of the ACA.
Overall, 57 percent of those surveyed said congressional Republicans should work with Democrats to improve the law, though just one-third of Trump supporters agreed. And nearly four-fifths of respondents, including just over half the Republicans, said the Trump administration should do what it can to make the law work — compared with 17 percent who said the administration should try to make the law fail so it could be replaced later.
Asked during the call with reporters whether the White House is signaling that it is receptive to the coalition’s approach, member Lanhee Chen, a research fellow at Stanford University’s Hoover Institution said: “We are just getting started on that front.”