In the wake of Congress’ failure to repeal the Affordable Care Act along partisan lines, a debate is swirling around what comes next — including a “do-over” in the House. It hopefully ends in widely supported legislation that improves coverage, affordability, and quality in the long run. But to get there, it should begin with executive actions to support the Health Insurance Marketplace in the short run. It is hard to move forward on bipartisan legislation if executive actions take us backward.
For context, when officials like me left the Obama administration in January, key policies for 2017 and 2018 were set. Final rules and guidance were in place. Operational and outreach budgets were established. And in many respects, the system was on autopilot.
Yet, on its first day in office, the Trump administration issued an executive order setting agencies on an open-ended mission to reduce Affordable Care Act “burdens.” It suspended marketing during open enrollment. It declined to tell a federal court whether it would defend its current cost-sharing subsidy payments. And, it proposed changes to next year’s marketplace policies that have yet to be finalized.
Aside from these “knowns,” there are the unknowns as well. Politico broke news about a secret memorandum from the Office of Management and Budget about administrative actions to reduce essential health benefits. And Health and Human Services Secretary Tom Price promised to enact unnamed executive actions during “phase two” of the administration’s effort to repeal the ACA.
These are not inconsequential acts. They sow seeds of doubt in the marketplace and could leave consumers with fewer choices and higher prices.
Uncertainties created by the Trump administration no longer serve as the backdrop to a legislative drama. They are front and center as the hourglass empties for health insurers, marketplace teams, consumer assisters, and others to declare participation in next year’s open enrollment. Next week, April 5, was the original start of the plan application process had the Trump administration not delayed it.
Given this schedule, it is probably too late for Congress to affect premiums and choices for 2018. Indeed, the Congressional Budget Office assumed the repeal bill’s marketplace policies for 2018 could be not implemented in time.
For this reason, all eyes should be on finalizing administrative policies that promote marketplace growth. The uncertainty created by recent events and President Donald Trump’s predictions of an “explosion” cannot be undone. It will likely add to the cost of future premiums. Yet, this unnecessary cost to consumers could be reduced with three simple administrative actions.
First, the Trump administration should commit to paying cost-sharing subsidies that reduce deductibles for working-class Americans. Alternatively, House Republicans should drop its unprecedented lawsuit challenging the subsidy. Insurers made clear that the threat of losing $7 billion a year would cause them to hike premiums or exit the marketplace altogether. This could happen this year if the Trump administration acts irresponsibly. But that threat could be easily eliminated by simple court filings.
Second, the administration should finalize marketplace-improving changes for 2018 as soon as possible. That said, it should not finalize policies that undermine consumer protections or financial support for the marketplace. For example, its proposal to allow insurers to lower the value of coverage offered through silver plans, which would both lower federal financial support by nearly $400 million per year and raise premiums for consumers. The administration should finalize only changes that experts agree will improve affordability, stability, and choices.
Third, the administration should commit to carrying out the law of the land. The open questions about enforcement of the current policy like the individual responsibility provision (a.k.a. mandate) created a chill among the administration’s partners. Other questions are whether the administration will maintain adequate customer services representatives at the marketplace call center and whether it will carry out marketing and outreach activities to attract young and healthy enrollees. This uncertainty could be ended by the administration simply stating that, unless changed, the past rules of the road remain in effect.
Why should Republicans as well as Democrats support coming to closure on stabilizing policies? The ACA is more popular than ever, and the marketplace may be poised for greater price stability and competition going forward — without policy reversals. Republicans could claim credit for running it competently. But if the administration chooses instead to undermine the marketplaces, the consequences will be blamed on Republicans. President Trump said last Friday, “The best thing we can do politically speaking is let Obamacare explode.” If they do, it’s on their hands.
As such, setting a steady course, lowering the temperature, and making the marketplace work for the millions who rely on it may be both good politics and good policy.
As such, let’s lock arms and lock down sensible 2018 marketplace policies.
Jeanne Lambrew is the former deputy assistant to President Barack Obama for health policy and currently is a senior fellow at The Century Foundation.
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