A Bipartisan “What’s Next” for U.S. Health Reform

[This past week, I was one of the co-authors of a consensus policy paper on short-term steps that would stabilize the ACA health insurance marketplaces and address some other urgent health policy priorities such as reauthorization of the Childrens Health Insurance Program (CHIP).  The paper was authored by a group of 9 policy experts (5 on the Republican/conservative side and 4 on the Democratic/progressive side).  While the ideas are not revolutionary, we show that bipartisan consensus is possible and offers hope for saner and more balanced policy — we hope!  Here is the paper below:]

The Congressional effort to repeal and replace the Affordable Care Act (ACA) has stalled, sparking urgent questions about what’s next and whether a bipartisan agreement could be achieved to address important U.S. health reform needs. We believe that critical matters relating to health reform must be addressed quickly and that bipartisan approaches are possible.

We are health policy analysts and advocates who join in this agreement. While we hold diverse political views and policy outlooks, we believe that health reform solutions exist that can transcend partisanship and ideology.

In this commentary, we describe our bipartisan agreement on five health policy matters that should be addressed by the end of the federal fiscal year, September 30. These recommendations are designed to provide stability in markets until a longer-term resolution can be achieved and, most importantly, to protect coverage and health care access for those relying on them now. Continue reading “A Bipartisan “What’s Next” for U.S. Health Reform”

Back to the Future with Speaker Paul Ryan

This past week at Georgetown University, House Speaker Paul Ryan proposed scrapping an essential component of the Affordable Care Act (ACA) that bans health insurance companies from imposing pre-existing condition exclusions on consumers and prohibits the practice of “medical underwriting” to discriminate against anyone with a current or prior medical condition. Instead, he proposed, states could re-establish “high risk pools” from which those with pre-existing conditions could obtain coverage, leaving standard health insurance only for the “healthy.”

Paul Ryan 2Christopher Lloyd

Wow. Ryan may or may not realize it – but his speech just changed the stakes regarding the ACA and the November 8 federal elections.

Prior to Ryan’s speech, conventional wisdom, as evidenced in Republican Congressional and conservative think tank proposals, was to preserve the ACA’s ban on pre-existing conditions, albeit only for those who maintain “continuous coverage.” This stance enabled Republican office-holders to affirm their support for the pre-ex ban, even as their proposals’ fine print would reintroduce medical underwriting. Continue reading “Back to the Future with Speaker Paul Ryan”

The Sounds of Silence in the Republican Debate

I had one mission last evening watching the Republican-Fox News debate among their party’s top ten presidential contenders: what, if anything, could we learn about the state of play regarding the Affordable Care Act and U.S. health policy?

What I observed: the impassioned debate about the Affordable Care Act/ACA/ObamaCare is over, even among Republicans.

Here is what I noted from the debate that referenced the ACA:

First, Ohio Governor John Kasich restated his strong support for his decision to expand Ohio’s state’s Medicaid program as enabled and financed by the ACA, invoking President Ronald Reagan as someone who “expanded Medicaid three or four times.” He emphasized Trump Kasichhow the expansion helps both Ohio’s working poor as well as the mentally ill in prisons. No apology, no retreat, and no damage or attacks from any of his rivals.

Second, asked about his prior public support for a Canadian-style single payer health care system, Donald Trump commented that “single payer works well in Canada and incredibly well in Scotland.” He said he wants a “private system without artificial lines around states” (so much for states’ rights) and opposes “insurance companies that make a fortune because they have total control of the politicians. Get rid of the artificial lines. Take care of the people who can’t take care of themselves.” Oddly, at the end of his closing statement at the very end of the program, he added, apropos of nothing: “We have to end Obamacare and make our country great again.”

Former Florida Governor Jeb Bush said he wants to “get rid of Obamacare and replace it with something that doesn’t suppress wages.” No indication of what the “something” might be.

Wisconsin Governor Scott Walker simply said he wants to “repeal Obamacare.”

That’s it. Except for Trump’s, none of the others’ closing statements mentioned the issue. Even Texas Senator Ted Cruz, in his lengthy litany of first-day-as-President actions, left executive action on the ACA off his list. Cruz, as many will recall, was the key instigator of the 2013 federal government shutdown as a final gasp to prevent implementation of the ACA’s insurance coverage expansions on January 1 2014.

The only question from the panel of three Fox news journalists relating to health reform was the one to Trump regarding his past support for single payer health insurance – more a Fox gotcha moment than a thrust into health policy.

I looked at dozens of news accounts of the program from journalists across the political spectrum. Obamacare/ACA merited no mention anywhere in the their accounts and analyses.

This is the sound of silence as the ACA disappears from the nation’s political radar screen.

Yes, U.S. health policy is becoming boring again, still a never-ending feast for the policy wonks, still a continuous hand-wringing exercise for patients and medical providers dealing with their daily challenges, and now a big nothing-burger for most Americans focused on other concerns.

On two other health related issues, we heard repeated statements of opposition to public funding for Planned Parenthood and, of course, strident statements of opposition to abortion where the focus put candidates on the defensive who are willing to allow abortion in cases of rape, incest, and to save the life of the mother.

And nothing about Ebola!

I am sure in future debates, the ACA will return and receive a higher profile. But temperatures are cooling and this program last evening was important affirmation.

Republicans’ New Bridge to Nowhere

It’s been nearly 5 and 1/4 years (63 months for those counting) since President Obama signed the Affordable Care Act into law.  Since then, Republican Congressional leaders have continually declared their intentions to advance their own plan to repeal the law and replace it with something else.  This took on new urgency this year because of the U.S. Supreme Court’s (SCOTUS) decision to hear the King v. Burwell lawsuit that would eliminate all insurance subsidies to ACA private coverage enrollees in the 34 states with federal — as opposed to state — run exchanges/marketplaces.

New federal data show that 6.4 million would lose their insurance subsidies if the Court rules for the plaintiffs (King) and against the government (Burwell).

All this year, Republican lawmakers in the Senate and House have been insisting they would have a replacement plan out and even scored by the Congressional Budget Office before a SCOTUS decision in late June (an assurance made by House Ways and Means Chairman Paul Ryan (R-WI).

1 McCarthy Rep
US House Majority Leader Rep. Kevin McCarthy (R-CA).

Now, House Majority Leader Kevin McCarthy (R-CA) has announced the Republicans will have no replacement plan to unveil until after a Supreme Court decision is released, expected late this month, and Senate Republicans are stating the same.  As Jon Cohn notes in the Huffington Post, not only is there no plan, Republicans have not even held a hearing on the matter — though they repeatedly berated Obama Administration officials, notably Health & Human Services Secretary Sylvia Burwell, for having no contingency plan in the event of an adverse ruling in the King case.

What about Congress? [asked Supreme Court Justice Antonin Scalia]  You really think Congress is just going to sit there while – while all of these disastrous consequences ensue?”  The Solicitor General responded “well, this Congress, I ….,” a response which generated laughter.

Some may quibble and point to a number of ACA replacement bills filed by various members.  None of them have even received a committee hearing, much less a committee markup, or a vote in either chamber.  The most prominent replacement proposal, the Patient CARE Act, from Sen. Richard Burr (R-NC) and Orrin Hatch (R-UT) and Rep. Fred Upton (R-MI), which has had two public unveilings since 2013, has yet to be translated into legislative language and sits as a well-trumpeted narrative description of a non-existent bill.

I believe it’s pretty plain what is happening here.  Republicans are quite capable of uniting around what they all oppose and quite incapable of uniting behind what they would propose as an alternative.  With firm control of the House and Senate, the GOP has a golden opportunity to advance a comprehensive and clear alternative to the ACA.  They just can’t do it — short, medium, or long term — it’s a bridge way too far for them.  A bridge to nowhere.