ACA as a whole is too difficult to fix; let's work on individual parts

ACA as a whole is too difficult to  fix; let's work on individual parts
© Thinkstock

After several efforts to repeal and replace the Affordable Care Act (ACA), Congress has reached an uneasy stalemate on passing comprehensive health-care legislation.

However, spurred by the administration’s decision not to fund the cost sharing subsidies (CSRs), Sens. Lamar AlexanderAndrew (Lamar) Lamar AlexanderThe Hill's Morning Report - How will Trump be received in Dayton and El Paso? McConnell faces pressure to bring Senate back for gun legislation Criminal justice reform should extend to student financial aid MORE (R-Tenn.) and Patricia MurrayPatricia (Patty) Lynn MurrayOvernight Health Care: Planned Parenthood to leave federal family planning program absent court action | Democrats demand Trump withdraw rule on transgender health | Cummings, Sanders investigate three drug companies for 'obstructing' probe Democrats demand Trump officials withdraw rule on transgender health The Hill's Morning Report - Progressives, centrists clash in lively Democratic debate MORE (D-Wash.) have put together a common sense agreement for a short-term bill to stabilize the marketplace, provide states more flexibility in covering their residents, and allowing more widespread usage of catastrophic plans. It's called the Bipartisan Health Care Stabilization Act of 2017, also known as the Alexander- Murray bill. 

I applaud the senators for their work and urge the president to reconsider his notion that support for the CSR payments constitutes “welfare” for insurance companies and instead see it for what it is — help for the low income to afford copayments and deductibles.  


The Alexander-Murray bill would help to strengthen the individual insurance markets, but the nation has many other health-care issues that need to be addressed in the near future. Such as, the need to extend expiring health-care resources for children and community health centers; reducing health-care barriers to access for veterans; a medical inflation rate that outstrips the growth of the overall economy, to name only a few.

One approach that has proven useful in gaining consensus at Ascension on complex operational reforms is to break down the challenging broader issue into its constituent parts. By doing so, the team picks up momentum by defining, and then solving for, discreet issues, and can build on small agreements to ultimately achieve larger goals.

Based on this experience, I have a modest proposal to break through the logjam that now stymies progress on health-care legislation. In order to achieve success, however, both parties will have to find it in their political interest to refrain from forcing discussion of every health-care issue into the “repeal and replace” box. The proposal is as follows:

  1. Focus on historically bipartisan issues that are largely separate from the ACA to build up momentum to tackle reforms in areas addressed directly by the ACA.
  2. Break down “repeal and replace” from an indigestible whole to a series of more digestible parts and then tackle each discrete issue without reference to whether it “repeals” or “protects” ObamaCare. The focus must shift from “repeal and replace” or “protect the ACA” to improving our health system.

The Children’s Health Insurance Program (CHIP) recently ran out of federal funding authority on Sept. 30. While the ACA did increase the federal matching rate under CHIP, the program is not considered a program tied closely to the ACA, and it has traditionally been re-authorized with strong bipartisan support. The parties have already laid the framework to reauthorize it and should finish the job as quickly as possible.

Authorized funding for the nation’s community health centers also ended on September 30. Like CHIP, Community Health Centers have always received strong bipartisan support. Community Health Centers also received a bump in funding through the Affordable Care Act, but they were not created by the legislation, and they will remain an important health-care delivery system whether or not the ACA is repealed and replaced. Sens. Roy BluntRoy Dean BluntGOP group calls on Republican senators to stand up to McConnell on election security in new ads Ex-CIA chief worries campaigns falling short on cybersecurity GOP group targets McConnell over election security bills in new ad MORE (R-Mo.) and Debbie StabenowDeborah (Debbie) Ann StabenowUSDA cuts payments promised to researchers as agency uproots to Kansas City USDA eases relocation timeline as researchers flee agency USDA office move may have broken law, watchdog says MORE (D-Mich.), both representing states where Ascension has a strong presence, have introduced a bipartisan reauthorization bill. Congress should move this legislation forward as soon as possible.

In August, Congress provided emergency funding for the Veterans Choice Act and continues to work on a bipartisan basis to re-authorize it with important modifications to serve the health care needs of veterans. The negotiations have not been easy, but they have been bipartisan, and Ascension strongly supports continuing this important process. Hopefully, neither party will feel that it gains by making a compromise more difficult. Our veterans need an improved program to serve their needs.

The debate over pharmaceutical pricing is anything but non-controversial. However, there have been several bipartisan proposals, like the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act, which eliminates barriers to generic competition and will reduce prices. These market-driven proposals will receive bipartisan support and will help to slow the rate of health-care inflation, a goal supported by both parties.

After gaining momentum from addressing patient needs in each of these crucial areas, Congress should pass the Alexander-Murray bill.

While ACA as a whole may be too difficult to find bipartisan cooperation, the individual parts should be able to be negotiated. Following passage of Alexander-Murray, Congress can then excise another piece of the Affordable Care Act, say health savings accounts or Medicaid reform, and tackle them in a bipartisan fashion in order to build momentum. It is vital to work together.

Time is short, and patients are in need. Congress should act now.

Anthony R. Tersigni, EdD, FACHE, is president and CEO of St. Louis-based Ascension, the nation's largest nonprofit health system.