Wednesday, March 29, 2017

Small Fixes For ACA

If Trump wanted to.

Section 1402, which appears on Page 119 of the ACA, is aimed at easing a problem that Trump himself has focused on: the onerous deductibles and other out-of-pocket expenses that often come with insurance plans on the ACA exchanges. The provision lays out a set of formulas that, in essence, requires insurance companies to waive some of the deductibles and other co-payments for lower-income families. Under 1402, the government is required to reimburse insurers for the cost of these waivers. About 7 million Americans benefit.


If the president and speaker were truly worried about unaffordable insurance, let alone the absence of a competitive insurance marketplace — how they have defined the “explosion” of Obamacare — they could simply agree to implement Section 1402. Congress could drop the suit, or the Trump administration could continue to fight it. Congress could even simply appropriate the money for the reimbursements.

Similar uncertainty surrounds another section of the law. Section 1342 promised to reimburse insurers that experienced extraordinary losses in the early years of the exchanges, when predictions about costs and revenue had to be made with no history to draw on. This program, called “risk corridors,” was derailed by a provision that Sen. Marco Rubio (R-Fla.) slipped into a broader spending bill in 2015. That, too, has caused insurers to flee.

Again, simply reverting to what the law clearly stipulates would help to stabilize the markets.


A third way Trump could enhance, rather than undermine, the opportunity for his constituents to get affordable health care. He simply has to keep his promise to bring prescription drug prices down to where they are in every other developed country, which is at least 40 percent below what we pay, based on my research. He could do it by using Medicare’s negotiating power, through a legislated set of price controls, or both.

The 40 percent cut could translate into a drop of 6 to 8 percent in premiums that the president has said are far too high. And it could reduce Medicare spending by $350 billion to $500 billion over 10 years, far more than the rejected Trump-Ryan bill was projected to save.


Democratic leaders should immediately bring forward these and other specific, apolitical agenda items. Similarly, their supporters should highlight them rather than sloganize over unrealistic wish-list items such as single-payer.

And the press should keep tabs. Issues such as these rarely make headlines, but how the administration and Congress decide them deserves at least some of the breathless attention we just gave the seesaw battle over repeal and replace.

Inaction by the Republicans to allow healthcare to die is as callous as the attempted passage of AHCA. 

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