A bipartisan group of governors, led by Colorado Democrat John Hickenlooper and Ohio Republican John Kasich have a proposal intended to stabilize the Affordable Care Act insurance markets and try to Trump-proof the law. They’ve written to House and Senate leadership to propose concrete steps to allow Obamacare to continue to work.
Previously, we have written that changes to our health insurance system should be based on a set of guiding principles that include improving affordability and restoring stability to insurance markets. Reforms should not shift costs to states or fail to provide the necessary resources to ensure that the working poor or those suffering from mental illness, chronic illness or addiction can get the care they need.
Based on these guiding principles, we recommend (1) immediate federal action to stabilize markets, (2) responsible reforms that preserve recent coverage gains and control costs, and (3) an active federal/state partnership that is based on innovation and a shared commitment to improve overall health system performance. Just as these proposals have brought together governors from across the political spectrum, we are confident they can attract support across party lines in both chambers of Congress.
The details, however, are what’s important. To stabilize the markets, they suggest Congress funds the cost-sharing reduction payments to insurers that Trump has been holding hostage, making sure that insurers will be reimbursed for subsidizing copayments, deductibles and other out of pocket expenses for lower income enrollees as they are required to by law. They also propose two years of funding for a program states can “use to create reinsurance programs or similar efforts that reduce premiums and limit losses for providing coverage,” and for Congress to encourage competition in areas that have only one insurance provider now by exempting insurers going to those counties from the federal health insurance tax on their exchange plans.
Here’s a big one that is largely out of anyone’s but the Trump administration’s hand—they recommend the individual mandate continue to be enforced to make sure that people continue to sign up for coverage. The administration has already signaled it won’t go after people refusing to enroll with penalties, as required by law, so outside of states creating their own mandate and penalties or Congress impeaching Trump, it’s hard to see how they can make that happen.