Marilyn Tavenner is president and chief executive of America’s Health Insurance Plans (AHIP), the national trade association representing the health-insurance community.
For all the uncertainty created by November’s elections, one thing is clear: The Affordable Care Act (ACA) is about to undergo significant changes.
It is also clear that certain parts of the ACA have not worked as well as intended, particularly for individuals who buy health insurance on their own. As the new administration and lawmakers develop specific proposals to repeal and transition, it is imperative that they understand: Changes can either begin a stable transition to a better approach, or they can bring about even more uncertainty and instability.
Some lawmakers have talked about immediate repeal and waiting years to replace. Others have talked about a stable, secure transition to a workable replacement. That’s what will work for the American people. As a longtime health-care expert and the leader of a group that represents the nation’s health insurers, let me suggest some straightforward steps that can make this possible.
First, the foundation of effective insurance markets is continuous coverage for everyone — those who utilize insurance to obtain quality care and those who are healthy but have insurance to protect them in case they get sick. Both types of consumers must be insured for coverage to remain affordable.
The individual mandate, requiring everyone to have insurance, will likely be removed. However, to continue the reforms that people want — such as making certain that those with preexisting health conditions can obtain insurance at an affordable price — we need to find alternative ways for people to get and stay covered.
Here’s why: If the majority of individuals purchasing insurance are those who require immediate medical care or have high-cost medical needs, that will undoubtedly raise costs and reduce choices. While there is no single “silver bullet” to ensure that people get and stay covered, we should use proven solutions from Medicare and private-sector employers, such as waiting periods or penalties for those who have had a break in coverage. Such continuous coverage incentives could go a long way to avoiding even higher premiums and fewer choices for everyone.
Second, it will be important for Congress and the new administration to send strong signals that they are committed to market stability in 2017 and 2018. Right now, millions of Americans are choosing a private plan for next year — and millions more will be covered by Medicaid.
The best approach to keep insurance affordable and markets stable would be to fund temporary, transitional programs. These would include maintaining subsidies for low- and moderate-income individuals to purchase insurance and financial help for plans that enroll high-cost individuals, through at least Jan. 1, 2019.
There is no question that this funding is contentious. But it is essential to deliver stable plan options and predictable premiums until a replacement plan can be designed, developed and deployed. It can help build an effective bridge from repeal to replace — without jeopardizing care and coverage for millions of Americans.
Third, Congress could reduce health-care costs for millions of Americans by eliminating the health-insurance tax on insurers. The Affordable Care Act taxes health-insurance premiums by more than $100 billion over 10 years, raising costs for seniors on Medicare, state Medicaid programs, small businesses and hardworking families struggling to make ends meet. Eliminating this tax — which has already been suspended for 2017 — will lower premiums that millions of families and businesses pay.
Finally, the new administration can take immediate action to bring down costs for consumers by implementing effective verification of individuals’ eligibility before they enroll in an insurance plan. This would help prevent people from waiting to sign up for coverage until they’re sick, then dropping it when they’re better — which raises costs for everyone.
Americans deserve affordable coverage that works. The individual insurance market was a challenge before the ACA and continues to be one today. Whether citizens are covered through their employer or on their own, through Medicare or Medicaid, our commitment is to find solutions that deliver short-term stability and long-term improvement. Both are essential if repeal and replace is going to work.