In a year when congressional Republicans have been all too eager to roll back coverage gains made under the Affordable Care Act and sabotage the law as long as it remains on the books, Senate Majority Leader Mitch McConnell earlier this month offered a glimmer of hope for a sensible path forward.
In a speech in his home state of Kentucky, the majority leader suggested that Senate Republicans might have to work with their Democratic colleagues on making sure the Affordable Care Act works if the health care bill he and other Senate Republicans have been working on behind closed doors doesn’t muster the 50 votes needed.
McConnell’s comment was a small bit of good news in a year when Republicans have put health coverage in doubt for millions of Americans. But it’s still far from certain his statement will translate into reality. It depends on the latest version of McConnell’s health care bill, released Thursday, not attracting enough Republican support.
If it doesn’t, clearing the way for bipartisan talks, then congressional negotiators need a list of sensible changes that could actually help the Affordable Care Act succeed.
Here are two starting points for discussion.
More people should be eligible for the law’s health insurance subsidies. The Affordable Care Act was designed to extend coverage to the lowest-income Americans through an expansion of Medicaid. Those in the next income tier — with earnings between 138 and 400 percent of the poverty level — who don’t have access to insurance through work are eligible for tax credits that defray the cost of insurance they buy on the individual market.
But if your income exceeds 400 percent of the poverty level — about $65,000 for a two-person household — you’re out of luck. Your insurance can still be unaffordable, but there’s no government support available to help you pay the bill.
Your options in this scenario? Buy an insurance plan that breaks the bank, or decide to go without coverage, violating the Affordable Care Act’s individual mandate and depriving insurance markets of customers who could contribute to those markets’ stability.
Andy Slavitt, who ran the Centers for Medicare and Medicaid Services during the last two years of the Obama administration, told the Washington Post last month that if he could change one thing about the Affordable Care Act, he would make tax credits available to those with higher incomes.
Address why health insurance is so expensive. While the debate over the Affordable Care Act and its repeal and replacement has centered on health insurance, that debate misses the bigger picture.
Insurance premiums are high because they need to cover the cost of health care. Health care is extraordinarily expensive, and it’s more expensive here in the U.S. than it is in virtually every other country.
The U.S. stands out among its peer nations in the Organisation for Economic Cooperation and Development for the prices its health care providers charge for procedures, the percentage of health care spending dedicated to administration, and the amount of health care provided in the form of tests and hospital admissions for problems such as asthma that can be treated in less expensive settings.
Of course, tackling the U.S. health care system’s price problem is much more complicated than adjusting subsidy levels and stabilizing insurance markets as they exist today. But the long-term stability of the U.S. health care system — and its economy, since health care accounts for 17.8 percent of the nation’s economic activity — depends on it.
We hope that Senate Majority Leader McConnell’s statement about working with Democrats will pan out, and that Republicans and Democrats will come to the table ready to take on the health care system’s fundamental problems — with a goal of ensuring all Americans have access to the health care they need.