Senate Republicans are set on repealing the Affordable Care Act (ACA) individual mandate as part of their tax bill. The move would save the government money (a reported $316 billion over the next decade) and pave the way for massive corporate and high-income tax cuts.
The mandate, which says Americans must buy health insurance or pay a tax penalty, is paramount to keeping the ACA afloat. It gives healthy Americans an incentive to buy health insurance. If only people who are sick — and therefore expensive to insure — buy health insurance, insurers must hike premiums or stop offering plans, which prices both sick people and healthy people out of the market. Some 13 million people are projected to lose coverage as a result of overturning the individual mandate.
And, so, the proverbial death spiral Republicans have long cited as one of their many reasons for the law's repeal begins.
But to shore up crucial swing votes for the tax bill, Republicans might try something new: Pass bipartisan health care legislation — specifically a bill negotiated by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash, — in tandem.
The bill attempts to stabilize health insurance markets by easing state innovation waiver requirements and mandating cost-sharing reduction payments (CSRs), which President Donald Trump stopped making to insurers in October.
A case for fixing Obamacare
As of now, rumors of Obamacare's death spiral have been exaggerated. In fact, there's new evidence to support improving the law, not scrapping it. Two weeks in, numbers released by the Centers for Medicaid and Medicare Services show 2018 open enrollment signups are up 40 percent over last year.
It's too soon to know whether the increase will stick. Open enrollment lasts only 45 days this year, as opposed to 90 days previously, so more people may be shopping early as opposed to shopping in general. But there's other data — and anecdotal evidence — to suggest many Americans are finding affordable — even free — health plans. Per the Kaiser Family Foundation, about 4.5 million Americans can currently find a Bronze plan for $0 on Healthcare.gov.
Those $0 plans, incidentally, are the direct result of Trump's decision to nix CSRs, the exact subsidy Alexander-Murray seeks to fund.
Strong marketplace health isn't universal. A few state exchanges are in crisis. Almost every county in Iowa, for example, lacked an Obamacare insurer until June, when Medica agreed to provide coverage at a 43.5 percent average premium increase. On top of that, many Americans who don't qualify for Obamacare subsidies are finding high prices on Healthcare.gov.
But the positive enrollment numbers follow months of political uncertainty and a persistent effort from Trump to undermine his predecessor's signature legislation. On top of the short enrollment period and CSR cut, Trump slashed the ACA advertising budget, rolled back its birth control mandate and expanded access to cheaper association health plans — the latter another move that could draw more healthy Americans away from the ACA exchanges.
That the ACA persists in spite of these obstacles suggests the law could thrive if federal and state governments focused on improving the law instead of undermining it.
Commentary by Jennifer Fitzgerald, the CEO and co-founder of PolicyGenius, an independent digital insurance company for consumers. Previously, she was a junior partner at McKinsey & Company where she advised Fortune 100 financial services companies on marketing and strategy. She is a graduate of Columbia Law School and Florida State University. Follow her on Twitter @jenlfitzgerald.
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