The failure of the most recent Republican attempt to repeal and replace the Affordable Care means that Obamacare will likely be with us for the foreseeable future. This political reality has given a boost to those in Congress who want to fix problems in the existing legislation.
A bipartisan group in the House calling themselves the Problem Solvers Caucus is leading an effort to reform Obamacare. The roughly 40 members of the caucus are focused on stabilizing the system while avoiding raising the federal deficit.
The Problem Solvers want to repair Obamacare, at least in the short run, by:
- Stabilizing the state exchanges by guaranteeing federal subsidy payments (known as cost-sharing reductions) for insurance companies.
- Easing the burdens on small employers by increasing the size of companies that must offer health insurance (from 50 employees to 500) and defining the “full-time” workweek as 40 hours (up from 30).
- Creating a federal stability fund to reduce the premiums for high-cost patients.
- Encouraging states to experiment with ways to save money.
- Keeping most ACA taxes. The Problem Solvers want to eliminate the 3.2 percent tax on medical devices, but keep the law’s added taxes on high earners.
Writing in the Health Affairs Blog, Robert Pozen of the Brookings Institution has analyzed the proposals and offers a few ideas of his own. Pozen thinks the Problem Solvers could go further by:
- Allowing Medicare to negotiate drug prices, which is supported by more than 80 percent of Americans.
- Preventing enrollment abuses by toughening the rules for signing up for insurance outside of the enrollment period, a key worry for insurance companies.
- Offering insurance in uncovered counties through the Federal Employees Benefits Program, using the federal system as a backup in sparsely populated counties lacking even a single insurance provider.
- Encouraging younger, healthier enrollees by offering tax credits or allowing insurers to charge younger adults less than they can now.
- Expanding the use of health savings accounts in conjunction with Obamacare plans.
- Keeping the Cadillac tax on high-cost plans, but with adjustments: Lower the threshold for the tax, to discourage high-cost plans, while allowing high-cost states such as Alaska to adjust the threshold higher.
- Abolishing the Independent Payment Advisory Board, a panel designed to reign in Medicare costs that has yet to begin functioning and has faced bipartisan opposition.
With this growing list of proposal for improvements in the ACA legislation, lawmakers can’t claim that they lack for ideas when it comes to improving the existing health-care system.