Neera Tanden is president and chief executive of the Center for American Progress. Topher Spiro is the group’s vice president of health policy.
You’d think that Republican leaders would have learned their lesson after a second failed attempt to pass the Better Care Reconciliation Act (BCRA) — the Senate GOP’s replacement for the Affordable Care Act. It should come as no surprise that a bill drafted in secret — without holding a single public hearing or garnering the support of a single health-care stakeholder — would face widespread condemnation.
Nonetheless, once it became clear Tuesday that at least three Senate Republicans would block Majority Leader Mitch McConnell’s last-ditch, repeal-only bill, President Trump tweeted petulantly that Republicans should just let Obamacare fail. Setting aside the fact that, according to the nonpartisan Kaiser Family Foundation, ACA insurance markets are actually in the process of stabilizing, the last thing Americans need right now is for policymakers to double down on partisan political games.
There’s a better path forward. The American people have voiced an undeniable desire to see leaders from both parties come together and forge a stronger health-care system for all. In fact, a recent Kaiser poll found that 71 percent of the public wants Congress to make a bipartisan effort to improve the ACA. That includes nearly half of those who voted for Trump.
We have proposed legislation that could easily command a supermajority in Congress and help to restore the public’s faith in the ability of our political institutions to govern. Our plan calls for the Senate to pass those portions of the BCRA that would help stabilize insurance markets and eliminate those sections that would gut Medicaid funding and other federal subsidies while slashing taxes for the rich.
This approach consists of three core elements. First, it would provide greater certainty for insurers by guaranteeing continued payments of ACA subsidies, a step that could help reduce average premiums by as much as 19 percent.
Second, it would reimburse insurers for covering high-cost patients who need more expensive medical treatments. Such a solution has already proved effective in Alaska, which cut the rate of premium increases by 75 percent, and in Maine, where premiums fell by 20 percent in the first year after it was enacted. We estimate that providing $15 billion to states for this kind of reinsurance would help lower premiums by more than 14 percent. Furthermore, because this funding would lower premiums, it would save money on tax credits — resulting in an overall cost of slightly more than $4 billion per year. Working together, Congress could easily find health-care savings to pay for this reinsurance.
There should easily be majority support for both these proposals, as guarantees of ACA subsidies and reimbursements for high-cost patients are already found in the BCRA.
Finally, because the first two components of this plan would take time to fully transform market dynamics, our plan also seeks to assist those areas of the country that have one or no insurers. Republican senators such as Bob Corker and Lamar Alexander of Tennessee and Democratic Sen. Claire McCaskill of Missouri have previously supported the idea of filling insurance gaps for these underserved counties.
There are several gap-filling options that Congress can and should consider. In counties that were underserved as of July 1, insurers could be exempted from paying the health-insurance tax. The government could offer a public option in the form of a guaranteed choice plan in communities without sufficient competition, particularly rural areas. People in underserved counties could be allowed to buy into the Federal Employees Health Benefits Program.
The three components of this proposed bipartisan solution would quickly earn the overwhelming support of insurance commissioners, actuaries, economists and policy experts from across the political spectrum. Most important, the plan would help to lower premiums, stabilize insurance markets and expand security for the American people.
The Republican Party faces two paths. It can continue to pursue its destructive efforts to repeal the Affordable Care Act, or to fuel uncertainty, while the American public holds it responsible for all the repercussions. Or it can join forces with the Democratic Party to help make the vision of affordable health insurance a reality for every American.
It’s time to stop using health care as a political weapon. With both parties invested in the solution, they would have an incentive to make it work. The time for bipartisan action should be now.