09.12.17

By: Editorial Board
Source: Los Angeles Times

If the GOP would only give up on repeal and replace it could actually make healthcare more affordable

Time is rapidly running out before health insurers have to commit to the policies and premiums they’ll offer next year to roughly 20 million Americans not covered by an employer-sponsored health plan. Although those premiums are expected to jump 10% or more in many states, Congress can rein in that increase significantly — if it acts quickly. Doing so, however, will require Senate Republicans to stop flirting with yet another partisan proposal to “repeal and replace” the Affordable Care Act, and start focusing instead on steps to make coverage more affordable that can win broad support.

The good news is that leaders of the Senate Health, Education, Labor and Pensions Committee, who have a reputation for pragmatism and compromise, are trying to pull together a narrowly focused, bipartisan bill this week that would have a direct and rapid effect on premiums. Although the details are still being negotiated, the measure is likely to continue reimbursing insurers for at least a year — and preferably more — for some $7 billion that the ACA requires them to spend on lower out-of-pocket costs for low-income customers.

Although the law requires the federal government to make those reimbursements, some Republicans have labeled them a bailout for insurers, and the Trump administration has threatened repeatedly to cut off funding. Those threats have led insurers to seek premium increases of 2% to 23% in 2018 just to pay for the cost-sharing reductions, according to the Kaiser Family Foundation.

That’s just one of the factors driving up premiums; others include the Trump administration’s indifferent enforcement of the ACA’s requirement that all Americans carry insurance, which encourages healthier adults not to sign up for coverage, and the unexpectedly large treatment costs incurred by those who do have policies. The Senate health committee’s bill may not address the rest of those issues directly. Instead, it’s likely to let states try to entice more healthy people to buy coverage by allowing insurers to offer less robust policies than the ACA requires, or by kicking in state dollars to help insurers.

A more direct approach would be to provide the sort of federal backstop that helps hold down premiums in Medicare’s prescription drug plans — such as reinsuring insurers against the cost of consumers with outsize medical expenses.

But even the Senate committee’s proposal would be better than one being floated by Sens. Bill Cassidy (R-La.), Lindsey Graham (R-S.C.) and Dean Heller (R-Nev.), which would replace the ACA’s insurance mandate and subsidies with a complex system of aid to the states, while also reengineering Medicaidto gradually reduce Washington’s share of its costs.

The Cassidy proposal has until Sept. 30 to pass by a simple majority, after which it would need an unattainable 60 votes to overcome a certain Democratic filibuster. It's irresponsible for Republicans even to flirt with so major a proposal, let alone one so potentially damaging to California and other states with large Medicaid populations. Congress barely has enough time to pass a far more narrow bill to shore up the non-group insurance markets in time to affect the 2018 premiums. Lawmakers should focus on that, and get it done.