Healing the ACA and lowering costs

Since its enactment in 2010 as the centerpiece of former President Obama’s domestic agenda, the Affordable Care Act (ACA) has been a major source of debate and controversy. So while the ACA provided new coverage to millions of Americans, it has also had a number of unintended and undesirable consequences. We can either ignore these structural issues and hope for the best, or we can step up and fix the system so that Americans can have real health insurance reform at a reasonable cost.

As a freshman member of Congress, I’ve met with citizens who have expressed their satisfaction with the ACA. I’ve spoken to others, particularly small business employers, who are confronted with premium increases and unaffordable deductibles. We’ve got to fix what isn’t working in the healthcare law and keep what does work. Our first duty in this challenge is to be candid with the public about the ACA’s past promises and its present realities.

{mosads}The ACA’s architects predicted 22 million people would be enrolled in the healthcare exchanges in 2016; in fact, less than half that number joined. Too few young, healthy people have enrolled, leaving insurers with higher-than-expected expenses for those older people who remain on the exchanges.

Result: 36 percent of rating regions in the country have only one insurance choice for exchange participants. And now the carrier Humana has announced it will completely exit the exchanges in 2018. Increasingly, Americans seeking affordable health insurance choices face a monopoly.

Another critical shortcoming of the ACA is that it attempted to federalize the health-insurance marketplace. The Obama administration continually reopened enrollment periods, making it difficult for insurers to accurately estimate annual health costs. Skyrocketing premiums resulted as insurers sought to cover prior-year losses. President Obama had promised these families his law would reduce their premiums by $2,500 a year. In fact, premiums have risen by $4,300 for them.

Providing more certainty to the marketplace would reduce costs for small businesses which provide health insurance to their employees and also assist insurers in offering more affordable choices to those in the individual insurance market. A recent proposed regulatory change by the Department of Health and Human Services (HHS) does both. New York insurer CDPHP’s Robert Hinckley put it this way following the HHS announcement: “This is a good first step. As with any year, CDPHP is in the process of evaluating the marketplace to determine our level of participation.”

As readers of this newspaper know, there are a number of ideas and plans currently before the House and Senate. Some I agree with; others I don’t.

First, we should once again allow small businesses to band together and get insurance for their employees through association health plans, typically with the local chamber of commerce acting to link employers together.

Second, the federal government should reform ACA’s reinsurance program by funding state-based high-risk pools to pay for large medical claims so that no one is bankrupted because they or a family member have a serious illness. High-risk pools can also ensure that coverage is available to anyone with a pre-existing condition. Every proposal I’ve seen to fix the ACA continues this guarantee.

Third, maintain the provision in the law allowing young adult children to stay on their parents’ insurance up to age 26.

Fourth, provide coverage options to those New Yorkers and others receiving benefits through Medicaid. Almost one-third of my state’s population is enrolled in the program and approximately 700,000 people gained coverage under the state’s ACA-approved Essential Plan, a Medicaid offshoot fully funded by the federal government. I am working with my colleagues to continue coverage for those who benefited from the expansion, including by incentivizing purchase of private insurance with federal subsidies.

Fifth, support more community health centers to provide primary care services to those without access to a physician. We must also create incentives for additional primary care doctors, physician assistants and nurse practitioners to serve those rural and urban areas of our state without adequate medical services.

We will reform and fix the ACA in an open and transparent way. This Congress cannot repeat the mistakes made when then-Speaker Nancy Pelosi (D-Calif.) said that Congress had to pass the Affordable Care Act in order to find out what was in it. Reform will take place over the next few months and will be implemented over the next two years, giving health insurers time to prepare more flexible policies and to minimize uncertainty for providers such as hospitals and doctors. Devolving power away from Washington and giving patients more control and more choices will lead to lower costs. I’m committed to making it happen.

Rep. Faso represents New York’s 19th District.

The views expressed by this author are their own and are not the views of The Hill.