The Healthcare Plan No One is Talking About

Randy Robinson
Jul 20, 2017 · 6 min read
Representative Kurt Schrader (D-OR)

On July 10, 2017, I wrote about the huge opportunity congressional Democrats were missing by not putting forward a healthcare plan that would actually address the problems with the Affordable Care Act. I argued that the Democratic Party was at risk of becoming a party of “no” as opposed to a party of ideas, and that the failure to introduce real substantive policy proposals on healthcare (amongst other things) would come back to haunt them. At least ten congressional Democrats agreed (yeah, I’ll take credit, why not?), and three days later released a plan to address shortfalls in the ACA (see my summary of the plan below).

In introducing the plan, Representative Kurt Schrader (D-OR) said: “We need an alternative to the ‘just say no’ policy that has pervaded Democrats up until now. Let’s have that conversation. Let’s fix the damn thing and get real.” Yes, yes, yes! Sitting on the sidelines and watching the opposition implode may be a winning short term strategy, but it is not leadership. Moreover, in the long term it is a horrible strategy — just ask congressional Republicans, who after being a party of “no” for eight years are now struggling to develop policies that will actually work in the real world.

The plan released last week was put together by a group of ten moderate Democratic Representatives. This plan, unlike the Republican plans in the House and Senate, actually focuses on the biggest problem with the ACA, the individual market. The plan, titled “Solutions Over Politics: Stabilizing and Improving the Individual Market,” begins by stating that the “ACA has expanded health insurance to more than 20 million people, and consumers receive more coverage for their dollar,” but “we also acknowledge that many Americans struggle with the costs, particularly those in the individual insurance market.” This is a big admission as many Democrats refuse to acknowledge problems with the ACA because they believe such concessions would only strengthen Republican arguments to repeal it. By championing the positive effects of the ACA while at the same time acknowledging that it has problems that need fixing, Rep. Schrader’s group puts aside politics in favor of progress. For this they should be applauded.

Unfortunately, despite being the most well thought out plan released to date, no one is talking about it and it has received a tepid response from Democratic leaders who appear more interested in taking a political victory lap than in actually improving the lives of Americans. In a four paragraph statement, House Minority Leader Nancy Pelosi bashed Republicans and the Trump administration for its failures on healthcare, but devoted only a single sentence promoting the plan’s “promising ideas.” There has been no press conferences, cable news tours, or other indications of support from Democratic leaders.

Apparently, Pelosi and Democratic leaders believe they get more political miles out of bashing Republican failures on healthcare than they would if they actually fixed the problems with the ACA. More troubling is the fact that many Democrats seem to believe that even recognizing that the ACA has problems is akin to handing Republicans a victory, and thus are content to ignore the real pain of everyday Americans. Their desire to keep this around as a political issue outweighs any desire to actually do their job and govern — a perfect illustration of what is wrong with American politics.

This madness has to stop. Yes, Republicans face planted in their attempt to repeal and replace the ACA, and yes this failure is political fair game. But what Pelosi and other Democratic leaders must come to realize is that the American public is tired of the politics and just wants to see something get done. It is time for someone to stand-up and be the grown-up in the room. I commend Representative Schrader and his working group for putting forward a thoughtful proposal that seeks to address the real problems with the ACA. And while it was highly unlikely that such a proposal would make it through a Republican-led Congress, it is Pelosi and Democratic leaders’ unwillingness to throw their full support behind the plan that ensures that most of the American public will never know that there are elected officials out there who are actually working to improve the lives of their constituents. I guess that is just how politics work in 2017 — disgusting.

Summary of the House Democrats’ Plan

The plan is built on five broad proposals to reform the ACA that “will bring down costs for individuals and families, and help stabilize the individual insurance market.” Importantly, the plan recognizes that some of the most positive and popular aspects of the ACA, like its prohibition on excluding coverage based on preexisting conditions, are not sustainable in the absence of some type of reform. Even better it puts forward proposals to stabilize the individual marketplace and ensure that Americans can still afford care. While I am sure that the plan is not perfect (no policy proposal ever is), it is the first proposal put forward by either party that actually addresses the ACA’s core problems.

The plan calls for creation of a permanent reinsurance program as “a backstop against extremely high medical claims” that have increased due to the ACA’s pre-existing conditions mandate. Currently, low income Americans receive government assistance in paying copays and deductibles, and the uncertainty around the continuation of these payments has led several insurers to exit the exchanges or dramatically increase premiums. The plan calls for continuation of these payments to ensure that low income Americans can continue to afford healthcare.

Next the plan calls on Congress and the President to “promote coverage and ensure that people pay their fair share.” The basic idea is that the more people you have in the marketplace — particularly young healthy people who are the most likely to go without insurance — the more stable the individual market becomes. Thus, it is essential that “[t]he federal government enforce the individual shared responsibility requirement of the ACA,” and that congress consider “[a]lternative options, such as auto-enrollment in a health plan that includes basic health services.”

The plan also calls for the creation of more affordable healthcare options. Proposed options include allowing Americans who are near Medicare age to buy into the program early, and providing “targeted assistance by age and geography” to reduce individual costs in areas with high premiums and low competition. In an attempt to reach across the aisle, the plan calls on Congress to consider expanding the types of plans available to younger enrollees who may not need all of the benefits mandated under the ACA, and recommends additional action to “[e]nsure that health savings accounts (HSAs) are flexible and compatible with plans compliant with the ACA.”

Finally, the plan calls for a series of direct reforms to the individual market. Recognizing that many rural and urban markets are underserved, it proposes drawing “bidding areas in the individual market . . . to include a balanced pool of enrollees so customers in rural areas are not at a disadvantage.” To reduce churn in the individual marketplace, Congress should consider multi-year subsidy certification and creating additional options to “streamline coverage between Medicaid and the individual private insurance market.” There is some red meat for Republicans too as the plan calls for empowering states that want to “innovate on the exchange or enter into regional compacts to improve coverage and create more options for consumers. This plan, while not perfect, is a big step in the right direction. It zeros-in on the big problems with the ACA — the stability of the individual market, rising costs, and geographic inequities.

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