By George Kalogeropoulos & Shandon Fowler
August 6, 2018 at 5:00 am ET
Nearly a decade since the passage of the Affordable Care Act, the heated vitriol surrounding health care policy issues has only intensified on both sides of the aisle.
This political battle is particularly jarring, since Americans — in the face of rising and even accelerating health care costs — are increasingly finding common ground on health care reform. This should serve as a clear directive to elected officials: Put partisan bickering aside, and diligently focus on providing better health care for your constituents.
With that in mind, here are five ways that Republicans and Democrats can work together toward solutions that will benefit all Americans.
Let the individual market settle
The news of the Centers for Medicare and Medicaid Services reinstating risk-adjustment payments to carriers, along with approving a bipartisan reinsurance program in Wisconsin, will attract more carriers to the individual market, thereby increasing competition and value to consumers.
Now, let’s stop trying to change everything again. Instead of reigniting repeal efforts or skipping straight to some version of “Medicare for all,” reforms should be given the opportunity to take hold and further stabilize the individual markets.
Address off-exchange coverage
Despite last year’s unsettled individual market, “silver plan loading” resulted in many people paying less for coverage.
But roughly 10 percent of the individual market — high-income individuals and their families who do not qualify for ACA subsidies — has, in some cases, seen premiums triple during the ACA years. This has driven nearly a million people away from ACA-compliant coverage.
Solutions such as expanding association health plans and short-term, limited-duration insurance, and driving under-regulated alternatives like health care ministry cooperatives are less than ideal. Creating some kind of subsidy for high-earners that keeps them in the market would help a Republican-leaning constituency, while providing more healthy people to individual risk pools would help everyone in the ACA markets — something that Democrats would appreciate.
Consolidate government operations and expand private marketplaces
The mix of state-based and federally facilitated marketplaces for individual, subsidized coverage unintentionally perpetuates red state/blue state disparities in health coverage. It also increases administrative burdens that may ultimately be passed to individuals through higher premium costs.
Consolidating “back-end” information technology and regulatory operations through CMS while enabling private marketplaces to become the primary venue for individual insurance shopping and enrollment could save individuals, insurers, federal and state governments billions of dollars. It could also spur competition and innovation that reduce costs and increase value for consumers.
Fortunately, this scenario is not a hypothetical — it’s largely how Medicare Advantage works, and there is evidence that it is reducing costs and increasing value to consumers. These goals should certainly speak to both sides of the political aisle.
Repeal or rework the Cadillac tax
The Cadillac tax has already been delayed twice. Republicans dislike it because it is an excise tax that targets overly generous coverage, which may be disproportionately available in highly paid professions. Democrats dislike the flat, dollar-value calculations that disproportionately impact higher cost-of-living states in the Northeast and West coast — aka blue states — as well as collectively bargained, high-value union health coverage.
The ACA’s arguably least-loved provision would have been long gone already if it were not for its status as a tax — which means that it requires new legislation to remove it, rather than the reconciliation process that was used for the ACA and for GOP’s tax reform effort in 2017. Democrats and Republicans could both have something to take back to constituents if they could just get this one thing to the president’s desk for a signature.
Push for cost transparency and consumerism
Recent hearings on Capitol Hill and a bill with “bipartisan” right in the name, combined with statements and efforts by CMS head Seema Verma, have indicated that Washington has an appetite for finding common ground on cost transparency in health care. With 44 percent of Americans overall and nearly 65 percent of those with individual coverage on high-deductible health plans, the need for such consumer-centered solutions is greater than ever. Study after study demonstrate that cost is the key variable differentiating our health care system from others around the world that have kept costs lower while improving healthy outcomes for its citizens.
All of this renders health care as the obvious issue on which Republicans and Democrats can and should find common ground. Doing so could refashion health care from a divisive issue into what it actually is: an essential need for all Americans that can only properly and effectively be addressed if we all thoughtfully collaborate and cast partisan differences aside.
George Kalogeropoulos is the CEO and co-founder of private health insurance marketplace HealthSherpa. Shandon Fowler is the owner and principal of Four8 Insights, which is a benefits and health care consulting company, and Fowler is a paid consultant to HealthSherpa.
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