In Our View: Health Care in Crisis

Congress must take lead in debate after loss of subsidies, sharp rise in premiums

Published:

 

The need for Congress to seize the reins of the health care debate has never been clearer. Lawmakers should support a bipartisan effort led by Sens. Patty Murray, D-Wash., and Lamar Alexander, R-Tenn., a fact reinforced by several recent developments:

• The Congressional Budget Office last week estimated that the bill would reduce the federal deficit by $3.8 billion over a decade while stabilizing health insurance coverage under the Affordable Care Act — colloquially known as Obamacare.

• State officials announced that premiums for insurance plans on Washington’s Obamacare marketplace will increase an average of 36 percent next year — an unsustainable rate.

• And President Trump has chosen to halt federal subsidies to insurers, a provision of the Affordable Care Act that helps attract insurance companies to the marketplace and provides incentives for coverage of low-income Americans. A district judge in California has rejected an attempt by 18 states to force the federal government to reinstate the subsidies.

Given all of this, Trump’s frequent claims that Obamacare is destined to collapse might become a self-fulfilling prophecy, with a teetering health care system receiving a firm shove from Republicans. Following several failed attempts to repeal and replace the Affordable Care Act, Congress and the administration have eschewed common-sense moves to stabilize the market and secure health insurance for millions of Americans.

The CBO’s score on the Murray-Alexander proposal is particularly notable. “This nonpartisan analysis shows that our bill provides savings and ensures that funding two years of cost-sharing payments will benefit taxpayers and low-income Americans, not insurance companies,” the senators said in a joint statement.

Many conservatives in Congress have frequently criticized the CBO, claiming that previous projections have been inaccurate. These complaints should fall on deaf ears. If the latest projections are off the mark and the plan trims the deficit by, say, only $2 billion, that still is a victory for taxpayers. And it certainly is preferable to previous attempts to overthrow Obamacare that would have expanded the deficit and resulted in some 20 million fewer Americans having health insurance. A CBO report in August estimated that halting subsidies will increase the deficit by $194 billion through 2026.

The centerpiece of the Murray-Alexander proposal would allow states to offer so-called copper plans — lower-cost policies that appeal to healthy enrollees in the Obamacare markets. By attracting young, healthy clients, insurance companies can lower premiums in the long run and reduce federal subsidy expenditures.

Large increases in premium costs have rightly become a focal point of opposition to the Affordable Care Act. But leaders in Congress must recognize that those increases have been fueled in part by instability. Washington Insurance Commissioner Mike Kreidler estimates that 10 percent of next year’s increase can be attributed to Trump’s decision to halt subsidy payments to insurers.

The administration has argued that the payments are illegal and require Congressional approval, which reinforces the need for Congress to seek solutions. The Murray-Alexander plan has broad support in the Senate, but less robust support in the House of Representatives.

Still, as Murray and Alexander note, “the sooner Congress and the president act, the better.”