John Kasich, John Hickenlooper, other governors urge Affordable Care Act exchange fixes

Colorado Gov. John Hickenlooper, a Democrat, worked with Ohio Gov. John Kasich, a Republican, to draft a set of recommendations for how to stabilize the ACA exchanges.

With Congress poised to return from recess and speed through a measure to stabilize the Affordable Care Act exchanges, a bipartisan group of governors have offered up a blueprint for what they believe it should include.

The recommendations (PDF) are the brainchild of Colorado Gov. John Hickenlooper, a Democrat, and Ohio Gov. John Kasich, a Republican, and are endorsed by six other governors from both sides of the aisle. Hickenlooper will likely draw upon the ideas when he testifies alongside four other governors during a Senate committee hearing Wednesday on ACA exchange stabilization.

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In terms of immediate action from the federal government, the governors call for funding cost-sharing reduction payments through 2019, and enforcing the individual mandate until Congress comes up with a better incentive to get healthy individuals to enroll in coverage. 

A Trump administration official said this week that the administration supports stabilizing the exchanges, but would not say whether it will continue funding CSR payments or whether it would set numerical goals for health insurance enrollment.

The governors also endorsed creating a two-year stability fund—with $15 billion appropriated annually—to let states set up reinsurance programs or similar efforts aimed at lowering premiums. And to address dwindling competition on the exchanges, they want to allow residents in underserved counties to buy into the Federal Employee Benefit Program.

In addition to those immediate fixes, the governors outlined other reforms that the federal government and states can pursue in tandem to preserve coverage gains and control costs. For example, while many states pursue efforts to maximize marketplace participation, the governors said the federal government must support them by continuing to fund outreach and enrollment efforts. 

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Other suggested efforts include:

  • Shorten grace periods for nonpayment of premiums, verify special enrollment period qualifications, and limit exchange enrollment for those who are eligible for other programs in order to promote “appropriate enrollment.”
  • Modify and strengthen federal risk-sharing mechanisms, including risk adjustments and reinsurance, to augment the state stability funds.
  • Give states more flexibility in choosing reference plans for the 10 essential health benefits categories.
  • Streamline and coordinate the waiver submission and approval process, including an option for states to easily build on approved waivers in other states, and an option to fast-track waiver extensions.
  • Align priorities for value-based purchasing across all federal agencies and expand payment innovation projects to more states.
  • Promote consumer-facing websites and apps that let consumers shop for healthcare based on quality and cost

The governors concluded their letter by calling for a return to regular order when Congress tackles immediate fixes for the exchanges, saying committees must “work in an open, transparent and bipartisan manner.” 

Sen. John McCain, R-Ariz.—whose dissenting vote tanked the GOP’s last-ditch effort to repeal the ACA in July—made a similar case in an op-ed published Thursday in The Washington Post. McCain argued the same point while his party was crafting its various ACA repeal measures.

“We might not like the compromises regular order requires, but we can and must live with them if we are to find real and lasting solutions,” he wrote. “And all of us in Congress have the duty, in this sharply polarized atmosphere, to defend the necessity of compromise before the American public.”