'Reform and fix' the Affordable Care Act
Issues surrounding the Affordable Care Act (ACA) have been a major source of debate and controversy over the past seven years. Enacted in 2010, the ACA was the signature effort of President Obama to lower the number of uninsured individuals in our nation. While it did provide new coverage to approximately 20 million Americans – 12 million under Medicaid and 8 million on health exchanges – it has also had a number of unintended and undesirable consequences.
I’ve met with citizens who’ve told me of their satisfaction with the ACA; I’ve also spoken to many, particularly small business employers, who are confronted with premium increases and unaffordable deductibles. We’ve got to fix what isn’t working in the healthcare law and keep what does work. Our first step is to be candid about the ACA’s promises and its consequences.
ACA’s architects predicted 22 million people would be enrolled in the healthcare exchanges in 2016; in fact, less than half that number joined. Too few young, healthy people have enrolled, leaving insurers with higher-than-expected expenses for those older people who remain on the exchanges. Result: 36 percent of rating regions in the country have only one insurance choice for exchange participants.
A critical shortcoming of the ACA is that it attempted to federalize the health-insurance marketplace. The Obama administration continually reopened enrollment periods, making it difficult for insurers to accurately estimate annual health costs. Skyrocketing premiums resulted as insurers sought to cover prior-year losses. President Obama had promised these families his law would reduce their premiums by $2,500 a year. In fact, premiums have risen by $4,300 for them.
We can either ignore these structural issues and hope for the best, or we can step up and fix the system so that Americans can have real health insurance reform at a reasonable cost. There are a number of ideas and plans currently before the House and Senate. Some I agree with; others I don’t.
First, we should once again allow small businesses to band together and get insurance for their employees through association health plans, typically with the local chamber of commerce acting to link employers together.
Second, the federal government should reform ACA’s reinsurance program by funding state-based high-risk pools to pay for large medical claims so that no one is bankrupted because they or a family member have a serious illness. High-risk pools can also ensure that coverage is available to anyone with a pre-existing condition. Every proposal I’ve seen to fix the ACA continues this guarantee.
Third, maintain the provision in the law allowing young adult children to stay on their parents’ insurance up to age 26.
Fourth, provide coverage options to those New Yorkers receiving benefits through Medicaid. Almost one-third of our state’s population is enrolled in the program and approximately 700,000 people gained coverage under the state’s ACA-approved Essential Plan, a Medicaid offshoot fully funded by the federal government. I am working with my colleagues to continue coverage for those who benefited from the expansion, including by incentivizing purchase of private insurance with federal subsidies.
Fifth, we need additional community health centers to provide primary care services to those without access to a physician. We must also create incentives for additional primary care doctors, physician assistants and nurse practitioners to serve those rural and urban areas of our state without adequate medical services.
We will reform and fix the ACA in an open and transparent way. This Congress cannot repeat the mistakes made when then-Speaker Nancy Pelosi said that Congress had to pass the Affordable Care Act in order to find out what was in it. Reform will take place over the next few months and will be implemented over the next two years, giving health insurers time to prepare more flexible policies and to minimize disruption for hospitals and doctors. Giving patients more control and more choices will lead to lower costs. I’m committed to making it happen.
John Faso, R-Kinderhook, represents the 19th Congressional District, which includes parts of Dutchess County.
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