As TMG Senior Advisor Arnold Buchman’s opinion piece suggests, the wholesale repeal of the ACA will do far more harm than good. Millions will lose coverage, care costs will continue to grow, and the risk pool – which, when broadened “yields accurate underwriting” – will shrink, driving premiums ever higher.
We agree with Arnold’s assertion that repeal of the ACA will result in “excessive financial risks.” It is unacceptable that hardworking men and women of all ages may again have to worry that one hospital stay will result in financial ruin or that a minor illness years ago will result in the rescission of insurance coverage when it is needed most. As The Margolin Group has done so many times in the past, we are prepared to guide our clients and the broader consumer market through the change that will ensue.
We believe there is likely no escaping at least some of the harm such a drastic about-face in health policy will cause. Given what is at stake, we advocate for a thoughtful “retain and repair” approach to improving the ACA. At a minimum, we suggest:
- Stabilizing the risk pool. The individual mandate should be strengthened, not repealed, as suggested by the current Administration. The goal should be to assure all – sick and healthy, young and old alike – contribute to the long-term sustainability of the risk pool.
- Reviving growth of the Consumer Operated and Oriented Plan (COOP) program. These “grassroots” health plans can and should inject healthy competition back into the insurance market. While several have failed, we believe that these plans, unencumbered by regulatory constraints around marketing, benefit design and pricing (along with a dose of federal funding to “even the playing field” with large, established insurance plans enjoying a broad member base), can provide an important check on the consolidating health insurance market. Eventually, greater competition will result in lower premiums for consumers.
- Retaining care coordination efforts (many of which were incubated by the Center for Medicare and Medicaid Innovation). Early studies of the Medicare Shared Savings Program, for instance, appear promising, but need further review and refinement. We have experienced firsthand how payer-provider collaboration activities improve the quality and affordability of healthcare. The Win4RI program – a strategic alliance between the second largest hospital system, the largest physician organization and the largest insurer in Rhode Island – has resulted in better care and reduced costs for patients in need. Across the nation, these collaborative efforts hold great potential.
The health insurance market demands stability to thrive. A “retain and repair” approach that continues to secure the insurance risk pool and generates innovation provides this stability. In fact, this approach has worked effectively as a strategy to improve other large pieces of progressive legislation throughout our nation’s history.
The Smith-Lever Act 0f 1914 established the USDA and was considered a “hodgepodge” of initiatives. With devotion to fixing what was broken and to retaining and advancing what was working, the legislation was modified over the years and has helped to reduce household food costs from 40% in 1900 to just 8% today. We have faced the challenge of improving imperfect legislation before, and we have had extraordinary success in a whole variety of sectors.
In healthcare, getting complex legislation perfectly right on the first pass is hard – perhaps impossible. “Staying the course” with subsequent amendments to the Social Security Act of 1935 (rather than replacing the law outright), for instance, has expanded healthcare for people 65 years and older and has resulted in fewer seniors living in poverty than before the turn of the 20th century. “Retain and repair” has worked in the past, and we should follow the same path to success here.
The ACA is not perfect. No law is. But we can and should leverage the law’s tools and protections to stabilize the risk pool, inject competition into the insurance market and drive care coordination. Through this tried-and-true retain and repair approach, let’s, together, arrest the crisis of escalating costs, unpredictable access to medical care and inconsistent quality and safety.