How Might Democrats Try to Expand and Improve the ACA in 2017?

[Below is a new commentary just released by the Milbank Quarterly on their website — to be published in their fall edition.]

In 2017, if Democrats hold the White House and recapture a majority in the US Senate (control of the US House is considered unachievable), how might they try to change the Affordable Care Act (ACA)?

Despite congressional gridlock, changes to the ACA have happened. Six years since its enactment, the ACA has been altered 24 times by Congress and the president, mostly in response to Republican demands that generated some support from Democratic lawmakers as in the 2013 wholesale repeal of the ACA’s Title VIII, a new disability cash assistance program known as Community Living Assistance Services and Supports (CLASS—RIP).1

While Democrats and progressive groups have wish lists for ACA improvements, they have kept these low-key, prioritizing instead the need to repel repeated existential threats to the law, such as the 2 anti-ACA lawsuits that reached the US Supreme Court in 2012 and 2015 (National Federation of Independent Business v Sebelius and King v Burwell, respectively). Continue reading “How Might Democrats Try to Expand and Improve the ACA in 2017?”

The Art of the Non-Deal Deal

[This article on the demise of the proposed ballot initiative to address hospital price variation was just published in the new summer issue of Commonwealth Magazine.  I first wrote about this issue in an article the winter issue of Commonwealth Magazine in January 2016.]

On May 31, Gov. Charlie Baker signed a new law to avert a proposed 2016 state ballot initiative that would have redistributed as much as $450 million annually from Partners HealthCare hospitals to most of the state’s other hospitals by establishing stringent limits on hospital price variation.  The new law, “chapter 115 — an act relative to equitable health care pricing,” is less than a shadow of the ballot petition advanced by the state’s health care workers union known as Local 1199 of the Service Employees International Union (SEIU).  Is the new law progress? Is it enough?

The clear winners are SEIU and Partners because both got what they most wanted, as well as Baker, Senate President Stan Rosenberg, and House Speaker Robert DeLeo who deflected the ballot question.  If anyone else wins, that is a matter of dispute. Less disputable are lessons about the state of Massachusetts health care politics and policy in the Baker era. Continue reading “The Art of the Non-Deal Deal”

Obama, Clinton and the New Public Option

The era of Democratic silence on strengthening and improving the Affordable Care Act is officially over.  President Barack Obama’s tour de force review of the ACA’s successes in the new Journal of the American Medical Association is also important for his identification of key ACA improvements needed on insurance affordability, Medicaid, prescription drug prices and more. I note his call for a “public option” health plan to spur competition in states with low numbers of health insurers participating in state ACA exchanges/marketplaces:

“…(I)n the original debate over health reform, Congress considered and I supported including a Medicare-like public plan. … Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited. Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government.”

Serendipitously, Sect. Hillary Clinton is now actively promoting the public option in her White House run, partially to woo backers of her Democratic opponent, Sen. Bernie Sanders (D-VT), and also because she has supported this idea since 2008:

“To make immediate progress toward that goal, Hillary will work with interested governors, using current flexibility under the Affordable Care Act, to empower states to establish a public option choice.”

What does the “public option” mean and why now? Continue reading “Obama, Clinton and the New Public Option”