AKRON BEACON JOURNAL (TNS)
John Kasich and six other governors offered good advice to the Senate leadership on how to advance repair of the Affordable Care Act. The Ohio governor and his counterparts from Colorado, Louisiana, Massachusetts, Montana, Nevada and Pennsylvania reminded that “true and lasting reforms are best approached by finding common ground in a bipartisan fashion.”
They urged the correct focus — “first and foremost … on improving our nation’s private health insurance market.”
What does that mean precisely? Most Americans get their health coverage through their employer or Medicare or Medicaid. What the Affordable Care Act has tried to do is make coverage more affordable and accessible for the 7 percent who purchase health insurance on their own.
For too long, many, often with chronic illnesses, or pre-existing conditions, could not find decent coverage that did not upend their household finances. The Affordable Care Act has improved their prospects, many now with the security of affordable coverage bought through the exchanges.
Yet this individual market still has problems. For many, adequate coverage remains out of reach. The deductibles are too high, or the policies skimpy. Add that the Trump White House has weakened the individual mandate and played coy with subsidies that help reduce the expense. Thus, uncertain insurers have pulled out of numerous states.
All seven governors, Republicans and Democrats, represent states that have expanded Medicaid coverage. The truth is, the expansion has delivered as promised, more people with coverage and doing better overall, especially in seeking and holding a job.
Put another way, as Kasich and colleagues suggest: Direct attention to the pressing problem, to repairing the individual market. The Congressional Budget Office and other independent analysts stress that the exchanges can work in a sustained and effective way. What is required is reinforcement.
Affordability goes to the right mix in the pool of insured, healthier people balancing those who are sicker. That turns on, among other things, an improved individual mandate, through stronger penalties and incentives. The exchanges need more realistic subsidies, reflecting the true cost of coverage.
Take the advice of the governors, and Mitch McConnell, the Senate majority leader, would halt the current hurried and opaque pursuit of a bad bill. Democrats and Republicans would sit down together to fix the exchanges for individual buyers.
They actually have much in agreement. Republicans originally put forward the ideas of the exchanges and the individual mandate. If the odds are long on such an effort, a pipe dream, really, the governors have defined a practical way forward. They’ve reminded how the work should get done.