DURING REPUBLICANS’ unilateral push to replace Obamacare with a flimsier system, they insisted that they were on a rescue mission to save a collapsing policy the Democrats had forced on the country. In reality, Obamacare was not the disaster they described, and their plans to replace it would have been far worse for needy people. The GOP effort fell apart, deservedly, last week.
Fortunately, a bipartisan group of lawmakers was at the same time quietly discussing how to fix, rather than replace, Obamacare. This group, the “Problem Solvers Caucus,” is split about evenly between Democrats and Republicans, and it released on Monday a modest plan that, if Washington were working, would be a viable bipartisan compromise focused on stabilizing health-care markets rather than enforcing one party’s will on the nation. Inasmuch as Obamacare needs rescuing, this is what a real rescue plan looks like.
Seeking bargaining leverage, President Trump has roiled health-care markets by threatening to withhold important federal payments to insurers, which fund a program that reduces out-of-pocket costs for low-income people. Without these cost-sharing reduction payments, insurers would have to raise premiums in order to finance the program or abandon markets that might become unprofitable to them. Insurance companies have made clear that Trump-induced uncertainty surrounding these payments has already forced them to raise prices. The caucus’s plan would fully fund the cost-sharing payments, immediately relieving uncertainty that is harming people’s access to insurance coverage.
The proposal would also set aside money that states could use to bolster their individual insurance markets in other ways. They could, for example, create reinsurance programs and other schemes that helped insurers cope with customers who required a great deal of expensive care. This would drive down premiums generally.
Though Republicans embraced these sorts of ideas in their repeal-and-replace bills, they would be unlikely to do so again absent a broader reform package. The compromise, therefore, includes some proposals more congenial to Republicans. It would curtail the mandate on employers to provide health insurance to their workers; advance states’ ability to band together into regional compacts in which insurance could be sold across state lines; and, expand the opportunity for states to experiment with different ways of covering their people.
Finally, the caucus’s plan sweetens the deal for the GOP by proposing to eliminate Obamacare’s medical device tax. This is its least defensible element. The multiyear drive to kill the tax is nothing more than an effort to please a special-interest industry with some powerful protectors in Congress.
The caucus’s plan is not the only conceivable Obamacare fix, but it is a serious, generally sensible proposal. Lawmakers should quickly approve it — or a comparable plan — before insurers finalize their premiums for next year.
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