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Affordable Care Act Advocates and Critics Agree on Health Care Recommendations

Washington, D.C. – 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. 

BPC’s recommendations are being released today after a six-month policy review with state health officials, policy experts, actuaries, consumer advocates, and health system and insurance industry leaders. 

The first stage proposes five near-term policies and recommendations designed to stabilize insurance premiums; encourage choice and competition; enhance flexibility for states to implement innovative solutions for their residents; and promote greater insurance enrollment by exploring a path towards alternatives to the individual mandate. 


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.  

“As a package, our recommendations aim to provide near-term relief to those Americans whose health care coverage is threatened by a fragile individual insurance market,” said former Senate Majority Leader Bill FristM.D., who co-chairs BPC’s Future of Health Care initiative. “This proposal will also help cultivate bipartisan compromise and trust among lawmakers so they can then focus on long-term solutions to improve the coverage, quality, and cost of health care for all Americans.”   

Our recommendations aim to provide near-term relief to those Americans whose health care coverage is threatened by a fragile individual insurance market.

“It is our hope that consensus on these interim policies can engender a level of mutual investment among both parties to make progress for the American people,” said former Senate Majority Leader Tom Daschle, who co-chairs BPC’s Future of Health Care Initiative. “Addressing the more long-term structural challenges in our health care system can only occur if Congress works across the aisle to create policies immediately that will stabilize the individual insurance market and bring down costs for consumers.”  

BPC’s proposal also explains the federal budgetary cost of each recommendation and provides a menu of policy options Congress could enact to offset any new spending. 

“We recommend that any combination of policies selected to offset spending for our proposal be achieved with a balance between providers and consumers of health services,” said BPC Future of Health Care Co-Chair Gail Wilensky. “The savings achieved from selected offset policies should equal, but not substantially exceed, the budgetary costs of the near-term policies.”   

The second stage of reforming the nation’s health care system focuses on a number of key areas that BPC believes policymakers should address, such as the ongoing opioid epidemic, soaring prescription drug costs, and potentially modifying or repealing the Affordable Care Act’s employer mandate. The group will study these areas and others in the coming months and develop recommendations.  

“There is bipartisan agreement for Congress to take action now to tackle the near-term challenges to our health care system that our recommendations target and then consider more longer-term affordability and sustainability issues,” said BPC Future of Health Care Co-Chair and Senior Advisor Andy Slavitt. “Our goal is to build a strong, bipartisan consensus on health care design features that slow rising costs, promote greater access to affordable insurance coverage, and improve the quality of care delivered to patients.”  

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