Dems, take lessons from the worst of the GOP health plans to improve ACA
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As Republicans stagger through the final steps in the death dance of repeal and replace, Democrats are starting to float proposals on how to build upon and strengthen the Affordable Care Act. In doing so, Democrats should respect the folks that brought them to the dance, the people who all around the country raised their voices to oppose the GOP taking away their healthcare. And to ask that government guarantee good health care they can afford.

Two recent proposals from Democratic groups, one from the Center for American Progress and the other from the New Democratic Coalition, agree on a pair of solutions to address problems created or exacerbated by both the Trump administration and Republicans in Congress.

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One proposal is to commit to funding the cost sharing payments to insurers (which were challenged in court by House Republicans and are now being doled out on month-to-month basis by HHS Secretary Tom Price).

 

The other proposal is to provide reinsurance to spread the costs of the most expensive patients among insurers. Republicans in Congress had cut funding for risk sharing during the Obama administration, deriding them as bailouts. Both of these proposals were part of the Senate Republican failed health bill, acknowledging that they are the minimum necessary to stabilize the insurance markets.

The New Democratic Coalition and CAP propose a number of other worthwhile measures to help stabilize markets and make coverage more affordable. But Democrats should stay far away from two coalition proposals that would make high deductibles worse. One proposal encourages more catastrophic, high-deductible plan for young people, who are in even less of a position to pay those deductibles than anyone else. The other would pave the way for more high-deductible Health Savings Accounts under the ACA, which means more government spending on primarily higher-income people.

To put it mildly, these are Republican-lite proposals that will alienate the people who Democrats relied on to defeat the GOP plan and will turn to in the 2018 elections.

Among CAP’s many positive proposals is one more that Dems should reject, waiving the tax on health insurers that agree to remain in markets with only one or no insurers. This is a wrongheaded approach that will cost the government money while doing no good. Health insurance companies will only remain in a market that is profitable, a point underscored by the “historically large profits” posted by the biggest health insurers this year. Once an insurer makes its business decision to stay in the market — only after demanding big premium hikes — it will be glad to grab the extra profit from not having to pay the taxes that help pay for coverage for people in the exchanges.

Democrats in Congress should build upon another proposal by the coalition: allowing some people near retirement plan to buy-into Medicare. A stronger version of this would be to lower the age of Medicare eligibility to 55, assuring that everyone near retirement has a more affordable choice of health coverage.

But it’s not just people near retirement who need a reliable, affordable health insurance option. The simple solution to insurance company blackmail is to have Medicare operate as an option in every insurance market in the country. Medicare has a better record of controlling health insurance costs than private insurance. And research has found that the presence of a major insurer brings down premiums in the health exchanges. By making the wildly popular Medicare program available in every exchange in the country, members of Congress can guarantee coverage, freeing themselves from decisions by insurance corporations.

The other approach that Democrats should take is suggested in another tepid form in the CAP proposal, which would accelerate discounts for brand name drugs in Medicare. Instead, Democrats should support President Trump’s call to have Medicare and Medicaid negotiate prescription drug prices. This wildly popular proposal would dramatically lower costs for prescriptions to the federal and state governments and to people on Medicare.

What Democrats in Congress propose will be a test of whether they understand the public outrage at the GOP plan to wreck the Affordable Care Act. The public wants to build on the ACA by strengthening the government’s role in making health coverage more affordable, without being kept at the mercy of whether private insurance companies and drug corporations can profit off of their care.

Richard Kirsch is the director of Our Story: The Hub for American Narratives and the author of "Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United States." Follow him on Twitter@_RichardKirsch


The views expressed by contributors are their own and are not the views of The Hill.