Category Archives: Affordable Care Act

Obamacare and an Opportunity for Compromise

Getting to the Middle

Everyone knows there are problems with Obamacare- even President Obama.

However, in both parties, the most vocal politicians also tend to be the least likely to compromise on solutions.

On the right, there are conservatives (such as Senator Rand Paul) who believe any form of government health care program is an anathema- and will never accept anything other than the full repeal of Obamacare. Point taken.

On the other end of the spectrum are the most liberal in Congress that look for more government involvement in health care, as exemplified by Senator Sander’s announcement this week that he intends to propose a “Medicare-For-All” single-payer system in Congress. Again- Fine. This is not a place to look for compromise either.

However, in between these bookends are many people from government, the provider community, and policy perspectives that are discussing interesting proposals to fix known problems with Obamacare. Let me briefly describe some of my favorites.

Five Potential Fixes for Obamacare

1. Control Drug PricesIf there was ever a topic for bipartisan support, it’s controlling drug prices. Both Hillary Clinton and Donald Trump (actually all Presidential candidates in 2016) included lowering drug prices in their campaign platforms.

As taxpayers, we should all agree to get rid of the portion of Medicare Part D that prohibits the government from negotiating drug prices for Medicare. The Affordable Care Act lifted that barrier, but it was not  implemented, although President Obama fought for it. The good news is President Trump is for competitive bidding as well.

Controlling drug prices should be an obvious first step to fix our current health care system. It will not be easy given the power of the Pharmaceutical Lobby, but it is an obvious place where politicians could meet in the middle to do the right thing.

2. Stabilize the Insurance Market

Last month CMS released proposed rules to help stabilize the insurance market in the Obamacare Exchanges. Presumably, the Trump administration did this in anticipation of the passage of the GOP bill (that has since been pulled) which relied on a transitional period when the exchanges would remain functional.

The proposed rules are what the insurance industry has been asking for. They are also changes that make sense- preventing abuses such as people jumping in the exchanges to avoid a tax penalty and jumping back out, making it harder to fit under the “special enrollment” exceptions, and letting states address issues of network adequacy– as states have done for at least the last three decades.

I have no reason to believe these rules will be suspended after the failure of the GOP Bill, but I hope I am right. Stabilizing the insurance market is all the more important if Obamacare will “be the law of the land for the foreseeable future.”

3. Maintain the Three-Year Funding Promised to States for Medicaid Expansion

States that expanded Medicaid under Obamacare had the price of that expansion covered 100% by the federal government for three years; after 2016 the states are to pay an increasing share of the cost up to 10%.

In his January 2016 State of the Union Address President Obama announced that any state that decided to expand Medicaid- at any time-  will get the same three-year transition funding.

Regardless of the current fighting over the future of Obamacare- or perhaps because of it- a number of states are currently questioning if they should expand as well (watch Kansas!).

Any state that chooses to expand Medicaid during the Trump Administration should get the same financial support promised by President Obama. That is just fair.

4. Allow More Flexibility in How States Expand Medicaid

While we are talking about expansion, we need to allow the states more flexibility in how they decide to expand Medicaid– if they chose to do so. Over the years, the Obama Administration demonstrated more flexibility in granting waivers, but not as much as requested, particularly by Republican Governors.

Let the states have increased opportunities to address the needs of their people- allow states to feel more control and ownership of their plan.

The whole point is to have a significant increase in the number of people in a state covered for health care. If that goal is achieved, the method should be flexible. We should encourage more innovation, not less.

5. Make the penalties higher

If the point is to enforce a mandate- it makes no sense to have the penalty within spitting distance of the product you want people to buy.

Having a mandate without any significant repercussion is a half-measure trying to please everybody. If a mandate is the path we are taking, the penalty needs to reflect that commitment

This List is Only the Beginning

There are many more ideas about fixing Obamacare available from multiple sources and divergent political positions.

But I have run out of space- and I expect- your patience.

Here is my point. We can fix Obamacare. There are plenty of ideas and solutions at hand.

The only true question is, do we have enough people in Washington willing to break the gridlock- who can put governing above party loyalty?

Fixing Obamacare is an excellent opportunity to show us they can.