5 Ideas That Could Be Part of a Bipartisan ACA Repair Plan

Republicans’ goal of repealing the Affordable Care Act (ACA) through budget reconciliation was defeated when 3 GOP Senators voted against a “skinny repeal” bill. Democrats have acknowledged the healthcare law is not perfect, but had staunchly refused to help Republicans repeal it.

Looking forward, it seems that the parties will now have to work together to pass legislative fixes that both sides of the aisle can agree on. While it may not be easy to cooperate after such a contentious battle, legislators and health policy experts have proposed some ideas that could be part of a health law compromise that addresses the ACA’s problems.

Here are 5 possible components of a bipartisan bill to repair, not repeal, the ACA.

1. Allowing states to opt out of some parts of the ACA

This idea was proposed by Senators Bill Cassidy (R-Louisiana) and Susan Collins (R-Maine) shortly after President Donald Trump took office and before the House even had a repeal and replace plan. Essentially, the Patient Freedom Act would preserve the consumer protections of the ACA, but allow states to choose to either stay in the exchanges or opt out of its mandates but still receive federal funding.

It was received poorly by Democrats at the time, with Senate Minority Leader Charles Schumer (D-New York) calling it “an empty façade that would create chaos.” However, it is possible that Democrats may be more open to the idea now that the prospect of total repeal is off the table.

2. Ensure cost-sharing reduction payments are made

The ACA’s cost-sharing subsidies, which are paid to insurers to help lower the costs of coverage for lower-income patients, have been in jeopardy since the new administration has threatened to stop making the payments. While they have so far been renewed each month, there is no commitment on how long they will be paid.

As a result of this uncertainty, insurers are looking to raise premiums or even withdraw from the exchanges. Anthem, for instance, recently said it needs “certainty quickly” or else it may leave additional states’ individual markets, according to Forbes. Legislation that makes cost-sharing reduction subsidies permanent may reassure payers and help stabilize the market, bringing premiums down.

3. Create reinsurance funds to mitigate the costs of sick patients

Reinsurance has been a common component of Democrats’ plans to repair the ACA and improve the marketplaces. A bill introduced in June by Senators Tom Carper (D-Delaware) and Tim Kaine (D-Virginia) would create a permanent $15 billion per year reinsurance fund intended to “offset larger than expected insurance claims” and boost enrollment in the exchanges, which would further bring down premiums.

Reinsurance funds were included in the ACA, but have since expired, leading to calls to make them permanent. These programs have also been proven effective in states. When such a fund was enacted in Alaska in 2016, the state’s sole insurer reduced its proposed 2017 premium increase from 40% to 9.8%, according to House testimony.

4. Expanding access to coverage for people in rural counties

A persistent problem with the ACA has been the withdrawal of insurers from individual insurance markets, leaving some rural counties with no options for marketplace plans. Proposed legislation from Senator Claire McCaskill (D-Missouri) would amend this by allowing people in such counties to access insurance through DC Health Link, the market that sells coverage to Congress and their staff in Washington, DC.

“The individual insurance market in Missouri needs fixing—and I think letting Missourians who don’t have access to a local insurance provider get the same plans that Congress gets, is a solid step that Republicans and Democrats can get behind,” said McCaskill in a statement announcing the bill.

5. Offer more affordable health insurance plans

According to a proposal from 10 House Democrats, there are a few fixes that would help make coverage more affordable for Americans. For instance, allowing people approaching retirement age to buy into Medicare would provide them less costly options through Medicare and Medicare Advantage programs.

Their plan also mentioned that health savings accounts (HSAs) should be “flexible and compatible with plans compliant with the ACA.” This provision would likely win approval from Republicans, as they have long called for the increased use of HSAs to pay for medical costs. They were prominently featured in House Speaker Paul Ryan’s (R-Wisconsin) “A Better Way” proposal, and mentioned as one of then-candidate Trump’s health policy ideas.