Though the Republicans’ efforts to repeal and replace the Affordable Care Act have fizzled—at least for now—flaws within the healthcare reform law remain and a bipartisan effort should coalesce around fixing the problems, according to one expert.
“Legislators can go one of two ways," wrote John S. Toussaint, M.D., the CEO of Catalysis, a firm that offers educational resources on the transition to value-based care, in a column for Harvard Business Review. "One is to leave the ACA as it is—and have Americans lose their health coverage and let premiums skyrocket. Improvements to the ACA will lead to expanding coverage, containing premium and Medicaid costs, and providing security for all Americans. The choice is clear.”
Toussaint, the former CEO of Thedacare, an integrated health system in Wisconsin, has three ideas for how Democrats and Republicans can put their differences aside to bolster the ACA. He suggests lawmakers:
- Open the door for more competition. One of the GOP’s chief complaints with the law is that premiums in some regions have risen to incredible heights because few insurers participate in local exchanges. As major payers like Aetna and Humana have significantly scaled back their exchange offerings or exited entirely (with Anthem poised to follow suit), this issue is not likely to be resolved on its own. The exchanges need to have robust risk pools to spread costs, Toussaint writes, so one possible solution is to allow states to offer cross-border risk pools. This isn’t the same idea as the GOP’s much-ballyhooed plans to sell insurance across state lines, he adds, but would instead allow states with limited exchange options to pool enrollees to better attract more insurers and increase price competition.
- Continue the push to reduce healthcare costs. The industry’s transition from a fee-for-service model to value-based care, a key element of the ACA, must continue if not accelerate, Toussaint wrote. Providers should be empowered to make these changes.
- Don’t forget poor Americans. The American Health Care Act’s drastic cuts to Medicaid drew ire from more moderate Republicans and Democrats, and the Congressional Budget Office predicted that the law’s provisions would lead to millions losing insurance. Touissant wrote that lawmakers should allow states flexibility to decide what works best for them, whether that is expanding Medicaid or choosing to leave the program as-is. Also important is education, he added, as many Americans who benefit from the ACA’s tax credits and other programs aren’t aware of them or how to use them.