The Bipartisan Policy Center’s Future of Health Care expert panel, which includes both advocates and critics of the Affordable Care Act, is calling for a two-stage approach to health care reform that would first stabilize the individual insurance market, and then work expeditiously to address the more fundamental structural challenges in America’s current health care system. These recommendations come after a six-month policy review with state health officials, policy experts, actuaries, consumer advocates, and health system and insurance industry leaders.
We come together in the shared goal that the current health care system requires immediate reform. Our internal deliberations, not unlike those in Congress, have been intense and at times quite challenging. We have divergent views on health care policy and differing opinions on the appropriate role for federal and state governments, private industry, and individuals. However, we share a deep concern for those Americans whose coverage is threatened by a fragile individual insurance market and are at risk in the absence of prompt, thoughtful, and bipartisan congressional action. We also believe that the capacity to address the more fundamental structural challenges in the current system can only occur if Congress works across party lines to reduce health insurance premiums through measures to stabilize the insurance market for the near term.
Fundamental structural challenges can only occur if Congress works across party lines to reduce health insurance premiums through measures to stabilize the insurance market for the near term.
Here we present a set of policies we see as having the most potential for meaningful short–term policy impact. While no member of our group would necessarily support each individual recommendation advanced in a vacuum, they combine our best thoughts on how to balance sound policy and political viability in a fashion that can be successfully advanced as early in the 115th Congress as is possible.
Through difficult negotiation reflecting the equity of discomfort that is inherent in reconciling substantive and political differences, we have developed the proposal that we release today. It is our hope that consensus from Congress on these interim policies can engender a level of mutual investment and trust amongst and between both Democrats and Republicans. We believe such investment is a precondition for constructive and productive bipartisan collaboration on the much broader set of long-term reforms that are necessary to improve and sustain the nation’s multi-faceted health care system.
Our approach includes two stages:
- To provide near-term relief and to help secure bipartisan compromise and trust, we propose a set of policies to immediately stabilize health insurance premiums; to promote choice, competition, and stability in the individual health insurance market; to explore policies to promote greater insurance enrollment with less reliance on the “individual mandate”; and to enhance flexibility for states to implement innovative solutions for their residents. Any costs associated with these policies would be fully offset so as not to add to the federal deficit.
- It is also necessary to move quickly beyond near-term fixes to consider more fundamental changes in health care: to build a strong, bipartisan consensus on its key design features; to slow rising costs; to promote greater enrollment in health insurance; and to improve the quality of care delivered to patients. We have identified some key areas where ongoing legislative changes should be made to make health care in America more affordable, accessible, reliable, and sustainable over the long-term, all the while retaining adequate incentives for innovation. As BPC Future of Health Care leaders, we are committed to reaching agreement on the reforms necessary to achieve these goals by year’s end, with the aspiration that the 115th Congress could act upon such reforms as soon as possible.
Five near-term policies and recommendations:
1. Provide health insurance cost-sharing subsidy reduction funding for at least Plan Year 2018 immediately, and for Plan Year 2019 by the end of March 2018;
2. Establish a Health Insurance Stability Fund that would award states funds that could be used for reinsurance, invisible risk pools or other mechanisms to address risk and lower premiums;
3. Give enhanced flexibility for states to implement innovative solutions for their residents through expedited approvals of State Innovation Waivers, also known as 1332 waivers, by shortening the application review time from 180 days to 90 days;
4. Allow greater use of Health Savings Accounts (HSAs) for consumers to cover their deductibles by temporary increasing the HSA annual contribution limits for self-only and family coverage to match the out-of-pocket limits for HSA-qualified High Deductible Health Plans for the same groups;
5. Develop alternatives (via the Department of Health and Human Services and Internal Revenue Service) to the individual mandate that do not have detrimental impacts on market stability and affordability.These would be developed over time as a state option and include automatic enrollment policies to promote greater insurance enrollment.