This morning, Governors John Hickenlooper, John Kasich and six other Governors released a plan to stabilize the private insurance market, to reinforce requirements under the Affordable Care Act (ACA) that ensure that coverage remains robust and affordable, and to provide greater flexibility for state innovation.
We recognize that a politically polarized Congress will inevitably struggle to develop and pass legislation, and appreciate this important, bipartisan effort.
Here are the key components of the plan:
* The plan proposes reforms to the ACA but lets stand — and sometimes reinforces — aspects of the ACA that have been proven to increase enrollment, improve risk pools, and improve affordability. Chief among those reinforcements is the continuation of Cost Sharing Reduction (CSR) funding for a minimum of two years. Any fewer than two years of funding would create turmoil for carriers, and make it impossible for them to set premium levels. Because ACA markets would cease to function without CSR, it’s our recommendation that CSR be funded permanently.
* Another welcome aspect of the plan is support for risk adjustment mechanisms in the ACA, including full funding for the risk-corridor program. Carriers that lost money in the early years of the ACA were not fully reimbursed, and as a result, carriers may have been deterred from entering new markets. Full funding could change that, bringing more carriers to counties that have few options. The Hickenlooper-Kasich plan would supplement those existing programs with a federal stability fund that states could use to start programs that help defray the costs of individuals with greater health care needs.
* By proposing to fix the “family glitch,” the plan seeks to bring additional lives in to the risk pool while opening up options for people who cannot afford coverage today. The family glitch has made it impossible for family members of employees who cannot afford employer sponsored health insurance to seek premium tax credits in the exchange.
* For those counties that may have no or only one carrier option, the plan also provides consumers with an additional choice – specifically opening up the federal employee benefit program to people in those counties. Evidence shows that the presence of more plan and carriers helps lower costs for consumers.
* Though it isn’t always popular, the plan proposes continuation of the individual mandate. Accompanied by measures that help keep coverage affordable – access to Medicaid and Children’s Health Insurance Plan (CHIP), premium tax credits and cost-sharing reductions – there is every reason to require that people get covered. The need for health care is often unpredictable, and it serves all of us to live in a county or town or state where our kids and their classmates have access to preventive care and treatment, where employees and co-workers can get care when they are sick, where we and our parents and neighbors can stay healthy as we age and get assistance when we need it. On top of that, having everyone covered means that all of us pay less.
The plan also proposes changes. It calls for more transparency, so that consumers can assess the quality of coverage and understand the cost of care. More flexibility is proposed for states in how they structure ACA waivers, also known as 1332 waivers. We support that as well, keeping in mind that the plan maintains the requirements that waivers keep coverage just as affordable and comprehensive as the standard ACA program. We are interested in any proposed regulatory changes, and would want to make sure that consumers are not harmed and that coverage of essential health benefits remains robust.
Thankfully, the plan does not include changes to the Medicaid program, which had been illogically roped into ACA repeal efforts this past spring and summer. Medicaid Works, both in terms of what it provides and by serving as the foundation for the private market. This is a set of proposals that Congress should take seriously. And though there is more to learn about the plan and how it might affect Coloradans in coming years, it is clearly the product of analysis and discussion, rather than rhetoric and dogma. And for that, we’re grateful.
-By Bethany Pray