Dive Brief:
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A series of policy changes involving the Affordable Care Act would cut the number of uninsured Americans by 12.2 million people, the Urban Institute said in a new report funded by the Robert Wood Johnson Foundation.
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Making the policy changes could bring the uninsured rate to 7.3% and save money for people struggling with healthcare costs.
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The Urban Institute said the policy changes, which would likely face significant opposition on Capitol Hill, would improve access and affordability, contain costs and stabilize the ACA exchanges.
Dive Insight:
The ACA helped cover millions more Americans, namely through Medicaid expansion. It also provided assistance to payers for covering sicker and lower-middle-class Americans and helped people in the non-group marketplace by offering tax credits to help pay for coverage.
The Republican Congress tried to repeal the act in 2017 but failed in the Senate. Nevertheless, the Trump administration has taken numerous whacks at the health law, which critics charge has weakened its provisions.
The ACA remains the law of the land despite the recent court decision declaring it unconstitutional. That decision will be appealed and legal experts say the decision is likely to be reversed.
In an attempt to offer ways to improve the landmark law, the Urban Institute suggested a series of changes: reinstate the individual mandate and cost-sharing reduction subsidies to payers, reverse the Trump administration's expansion of short-term health plans, expand Medicaid in all states, enhance the ACA's financial assistance, including tax credit eligibility, and introduce a federal reinsurance program for non-group coverage.
It also suggests capping provider reimbursements somewhere above Medicare levels for non-group coverage, which could reduce premiums and out-of-pocket costs.
The Urban Institute said a family of four with income at 350% of the federal poverty level, which is about $88,500, would save almost $1,900 on premiums. They would also face a deductible $3,300 less than under the current law. The report estimated that the policy changes would increase healthcare spending on acute care for people younger than 65 by 1.8%, or $39.8 billion, in 2020.
Probably the most controversial suggestion is capping provider payments. Provider groups will likely oppose this measure, but the report argued that placing caps on payments would increase competition. It would also reduce the possibility of a large provider requiring higher payments, increasing a market's overall reimbursement. Payers could also enter the market more easily because they wouldn't have to negotiate against established higher rates. Capping the payments would also lower healthcare costs, including federal spending.
"The Medicare Advantage program uses a similar approach by capping out-of-network payments at traditional Medicare payment rates. An alternative that achieves roughly the same savings, but could be somewhat more problematic politically, is a public option offered in the marketplaces," according to the report.
If the recent court decision from Texas is reversed, the ACA remains in place and Democrats and Republicans will need to figure out ways to improve the law, including making sure the exchanges remain stable. It's unlikely that Congress can pass legislation with all the Urban Institute suggestions. Republicans won't support bringing back the individual mandate penalty and legislators on both sides will likely oppose capping provider payments.
However, more states are expanding Medicaid, and Congress may support expanding financial assistance to help people pay for coverage, so there is a chance some of the ideas will become a reality.