Opinion

You’d Think Samuel Beckett Was In Charge of Our Health Care

Finding a path forward for the Affordable Care Act has been like waiting for Godot

Estragon and Vladimir — above as portrayed in a 1978 French production of Samuel Beckett’s “Waiting for Godot” — were stuck in limbo. After waiting on Congress to act on health care, we all know how they feel, Hoagland writes. (Fernand Michaud/Gallica Digital Library)

OPINION — Finding bipartisan agreement in Congress on a path forward for the Affordable Care Act has been like waiting for Godot. Polls tracking Americans’ views have consistently shown an evenly divided public. No single public policy issue captures the country’s polarization better than the debate that has surrounded this law.

That doesn’t mean we have to settle for “nothing to be done.” Improving health insurance markets is a goal worth pursuing, and Republicans and Democrats at the state level are already showing us the way.

First, some good news. The double-digit premium increases many markets have seen in recent years may have peaked, recent filings by insurers suggest. Nationally, the average 2019 premium hike for ACA plans appears to be about 5 percent. And officials in Connecticut, Maine, Maryland, Minnesota, Missouri, New Jersey, New Mexico, Pennsylvania and Tennessee are projecting a decline — 13 percent on average.

While low double-digit spikes will hit a few states, there will be many more in the single digits. Places like California, Indiana and Ohio are seeing relatively modest premium increases in the range of 3 to 4 percent. Factoring in tax credits, those figures could be even lower.

Now look past, for a moment, the well-documented political gridlock in Congress and the flashy battles over how the Trump administration is implementing the ACA. Strong and constructive bipartisan collaborations at the state level are quietly stabilizing the individual insurance market. And surprisingly enough, federal lawmakers can claim a sliver of the credit.

Riding the waive

The seeds of this state-based work were planted by Sen. Ron Wyden, Democrat of Oregon, and the late Sen. Bob Bennett, Republican of Utah. Their state-flexibility policy was amended into Section 1332 of the ACA. It allowed states, beginning last year, to test alternative health insurance coverage models through “state innovation waivers.”

In late 2015, the Bipartisan Policy Center issued a report highlighting this bipartisan provision and recommending that states take advantage of the innovations available to them. A number of states, seeing their residents were facing unacceptably high insurance premiums in the ACA marketplace, set up state-administered reinsurance systems to help insurers pay the claims of high-cost patients.

As they did this, the states worked with the federal government to secure Section 1332 waivers to help offset their own costs. They made the persuasive case that reinsurance payments would lead to lower premiums — and thus lower federal subsidy payments for those premiums. The state’s expense should therefore be offset, they argued.

Alaska was the first state to be granted a waiver by the Trump administration to help finance a reinsurance policy, and seven states have since had their own requests approved, most recently Maryland and New Jersey.

Look to the states

Things are unfolding much as they predicted — premiums are going down, and enrollment is going up. Alaska and Minnesota, two states that received waivers in 2017, project premiums will drop nearly 20 percent, while enrollment will rise 7 percent and 13 percent, respectively.

It’s clear the idea has promise. More flexibility, a bipartisan approach — that’s how we can redesign key elements of the health care law.

If we want to expand coverage and slash costs, we should look to this preliminary success as a model. We need a reinsurance mechanism throughout the nation to stabilize the non-group individual marketplace.

That’s why BPC recommended back in August 2017 and March 2018 that the federal government provide additional support for reinsurance initiatives in every state.

While there was strong bipartisan support in the House and Senate for this type of policy, we were disappointed that Congress was unable to act.

The 2018 elections are almost here and gone, and with them a string of overheated campaign ads. The question now isn’t who’s to blame for the state of health insurance in this country. The question is how wide a window we can open for states and the federal government to work together. Otherwise, we’re just stuck here, waiting.

G. William Hoagland is senior vice president at the Bipartisan Policy Center and the longest-serving staff director of the Senate Budget Committee.

The Bipartisan Policy Center is a Washington, D.C.-based think tank that actively promotes bipartisanship. BPC works to address the key challenges facing the nation through policy solutions that are the product of informed deliberations by former elected and appointed officials, business and labor leaders, and academics and advocates from both ends of the political spectrum. BPC is currently focused on health, energy, national security, the economy, financial regulatory reform, housing, immigration, infrastructure, and governance. Website | Twitter | Facebook

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