Dive Brief:
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Should legislation repealing the ACA’s mandate penalties and subsidies be enacted, 18 million people would find themselves uninsured in the first year following enactment, according to a recent report from the Congressional Budget Office. That number would increase to 32 million by 2026.
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There is another way to maintain coverage and fix the major weaknesses in the current system, Republican Congressmen Pete Sessions and Bill Cassidy and John Goodman of the Goodman Institute for Public Policy Research wrote in a Health Affairs Blog post.
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Included in their article are a number of ideas that are contained either in the Patient Freedom Act or in bicameral legislation introduced by Sessions and Cassidy.
Dive Insight:
In the face of frightening projections and an out-and-out dogfight between Republicans and Democrats over Obamacare, is it even possible to find a way to fulfill the law’s original goal of affordable health insurance for most Americans? The blog post authors say “Yes.”
They first address the problem of insurers shuffling the sickest people from plan to plan through high premiums and deductibles, while healthy people avoid getting insurance until they’re sick and really need it. They mention a “health status risk adjustment” and also question why we don’t imitate Medicare, imposing penalties on people who do not enroll as soon as they are eligible. But in the end, their proposed legislation simply “gives the states a great deal of discretion about how to deal with these problems.”
They propose a uniform tax credit and suggest that employers need the same tax credit in order to ensure fair competition between group and individual insurance markets. They do not, however, explain where the money will come from. One of their more innovative ideas is to transfer the tax credit to an employer for households in which a family member is employed. The tricky part would be getting employers to agree to this, especially given the administrative burden of managing benefits for employees who might not otherwise be eligible at all (due, for example, to part-time status).
Another innovative idea is to create a fund for the uninsured from unclaimed tax credits. In communities with more uninsured people, safety-net hospitals would receive more funding.
The authors make the remarkably neutral observation that fixing the marketplace might take a long time—a fact few politicians want to admit right now. Continuing to provide subsidies in the form of tax credits will ease the way for many Americans, provided that Republicans agree to them.