- A bipartisan group of eight governors released a plan Thursday to stabilize the Affordable Care Act (ACA) exchange markets and promote state innovation and the development of new payment reforms.
- The proposal is a mixture of quick fixes and long-term ideas, most of which are generally approved of on both sides of the aisle. The effort is spearheaded by Ohio Gov. John Kasich, a Republican, and Colorado Gov. John Hickenlooper, a Democrat.
- Meanwhile, President Donald Trump’s administration isn’t doing the ACA any favors. HHS announced Thursday it will be dramatically reducing the budget for ACA outreach and advertising by 90% and leave only $10 million remaining, Bloomberg reports.
Congress has a lot on its plate when it returns this week and a limited time frame for accomplishing it. Cost-sharing reduction (CSR) payments will be the focus of legislative healthcare efforts in the coming weeks, as few lawmakers are standing behind Trump’s plan to “let Obamacare implode” by stalling or denying the CSRs.
Without a commitment to the funding, insurers are saying they will have to dramatically increase premiums next year. Some payers declined to participate in the exchange markets at all because of the uncertainty around CSRs.
The highlights of the Kasich-Hickenlooper plan include making immediate CSR payments, stabilizing risk pools with a reinsurance program or something similar, encouraging more consumer participation in ACA marketplaces and fostering state ACA waivers. It’s hard to predict whether the governors’ plan will provide a foundation for Congress to move forward on the issue, but many of its ideas will be enticing to a relatively bipartisan audience.
The plan breaks with the Trump administration’s current strategy of refusing to promote or advertise the ACA exchanges. In addition to the massive advertising budget cut, HHS has dropped programs that focus on outreach to minority communities. Former CMS Administrator Andy Slavitt said on Twitter the massive cut in promotional funding is "a travesty" and could drastically decrease enrollment. "It's one thing to tweet the ACA is broken," he wrote. "It's another thing to purposely break it."
The new proposal from the governors promotes more outreach to young and healthy people, as well as providing adequate subsidies and encouraging continuous coverage. It also throws in something payers have clamored for — steps to limit signups outside of the open enrollment period.
The plan includes a section promoting value-based care, but contains few details on that issue. The governors encourage population-based and episode-based payment models along with wellness incentives and increased transparency surrounding costs and quality measures. Slavitt praised the plan and said it shows "how possible real solutions are."
The Kasich-Hickenlooper proposal also includes measures to streamline 1332 waivers, which allow states to sidestep essential health benefit requirements as well as change mandates and subsidies.
The GOP has been the driving force behind more flexibility for states as they implement the provisions of the ACA, but Democrats also approve of the broader concept. However, health policy experts have decried some of the more recent waiver submissions for being likely to bring back the problems the ACA was created to solve. The most conservative proposals include adding work requirements and asset testing to Medicaid eligibility and imposing mandatory premiums. The streamlining efforts in the plan announced Thursday are likely to trouble those who find these waivers problematic.