Let’s work to make the ACA even better

In the latest chapter of their continuous assault on the Affordable Care Act (ACA), congressional Republicans have set their sights on the premium tax credits that help Americans purchase health insurance through the exchanges. And in their efforts to score political points, they yet again show their indifference toward the millions of middle-class Americans who have benefited from this landmark law.

Last week, my Republican colleagues on the House Ways and Means Committee staged a purely political hearing that brought together not one but two subcommittees to attack the ACA. Through the guise of oversight, my friends on the other side of the aisle engaged in more than two hours of largely fact-free criticism of the premium tax credit income and data verification procedures at the core of signing up for insurance through the exchanges.


In my Republican colleagues’ view, even minor inconsistencies in the income and data verification procedures create an unsolvable crisis that requires starting over from square one. But the facts paint a different picture.

The reality is that we anticipated this issue when we wrote the ACA. That’s why we included provisions in the law that allow for several levels of review to detect and resolve inconsistencies. In the event that an inconsistency does affect someone’s tax credit, there is a process to resolve the issue at the end of the year. It’s a well-designed, fair process that ensures taxpayers are protected from overpayments and that all middle-class Americans get the tax credits they deserve.

We saw this coming because we’ve been through this before. A number of other programs that require verification of income and status, including Medicaid and the Children’s Health Insurance Program, have dealt with data inconsistencies. But despite similar implementation challenges, we’ve been able to make these programs great successes. We can do the same thing with the ACA.

There’s another important fact that the Republicans don’t want to acknowledge. Although there have been data inconsistencies, only a fraction will actually impact anyone’s tax credits. In fact, many relate to applications that were never even completed. And of the inconsistencies on completed applications, some are as simple as omitting a hyphen from someone’s name. Not every inconsistency means people are getting the wrong subsidies.

It also isn’t fair to say that none of these inconsistencies will affect people’s premiums. Some will. We understand that, and that’s why we have procedures in place to address the issue at the end of every year, called the “true-up” process. 

But Republicans don’t care about the facts. They would rather destroy the ACA altogether than deal with reality. Last month, they submitted a letter to Treasury Secretary Jack LewJacob (Jack) Joseph LewOvernight Finance: US reaches deal with ZTE | Lawmakers look to block it | Trump blasts Macron, Trudeau ahead of G-7 | Mexico files WTO complaint Obama-era Treasury secretary: Tax law will make bipartisan deficit-reduction talks harder GOP Senate report says Obama officials gave Iran access to US financial system MORE demanding an immediate, across-the-board halt to all premium tax credits. If they were to get their way, not one middle-class family — even those without inconsistencies on their applications — would have been able to benefit from these tax credits for the foreseeable future.

This is yet another disappointing example of Republicans’ insensitivity to the fact that the ACA is working. Access to quality health coverage has expanded dramatically since we enacted the law. Eight million people have bought insurance through the exchanges. More than 6 million middle-class Americans have saved money through tax credits. Another 6 million have enrolled in Medicaid. That’s success by any measure.

Now, access isn’t everything, and the law isn’t perfect. We must control the cost of care. 

But my Republican colleagues don’t seem interested in working on this issue. Instead, they stage politically motivated hearings and repeal votes, and rarely — if ever — offer constructive solutions. They have no alternative to the ACA, and all they can do is tear the law down.

It’s not fuzzy math or political spin to point out that the law is working. Just last week, a new Gallup survey showed that the uninsured rate in America is at the lowest point since Gallup began collecting such data. 

The bottom line is this: Republicans should join Democrats in discussing how to make the ACA even better.

McDermott has represented Washington’s 7th Congressional District since 1989. He is ranking member of the Ways and Means Committee’s subcommittee on Health, and also sits on the Budget Committee. He is a former U.S. Navy psychiatrist.